RFP #1002031048 - Replacement Medicaid Management ...

Replacement Medicaid Management Information System (R-MMIS) Questions and Answers Group III

Questions 44,64,81, 301 - 540

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RFP Reference Question Response

44 III-42 F.3.3 Call Center Operational Requirements

Regarding Member Call center operational requirements: • Where do the member calls referenced in the RFP get

answered today? • Are these toll free lines? • How many full-time- and part-time agents/staff answer

these calls today? • Please provide the top 10 reasons for member’s calls. Please confirm that with the implementation of the new State Enrollment Center the member call center referenced in the R-MMIS RFP will be to answer inquiries regarding fee-for-service programs and services for enrolled members only?

The pharmacy CCC does not currently receive calls from members. This information should be available from Medicaid Helpline staff.

The Enrollment Center will answer pre-eligibility determination questions, while the R-MMIS call center will answer post-eligibility determination questions regarding services.

64 III-55 M.2 Classifications of Staff

a). Would the State consider the PBM Medical Director as a shared (not 100% dedicated) position? Our experience in Medicaid PBMs has generally been that it is cost effective to have the contract Medical Director position shared across multiple clients as long as SLA’s are maintained and accessible when needed.

b). Would you please clarify if the State requires the Core staffing to be on site and available at contract inception or if the vendor may propose Core staff loading based on our experience?

c). Many of the PBM core positions are related to the Operational functions of the contract services. Would the State allow vendors to propose staffing of the Pharmacy core positions as needed a number of months ahead of Operation go live date subject to State approval of the vendor staffing plan? This will be more cost effective and bring on the necessary staff to participate in the DDI as needed. RFP stands.

d). Would the State consider the Rebate Attorney as a shared (not 100% dedicated) position. The rebate negotiation process where an Attorney is primarily needed would be limited to certain times during the contracting process. Allowing the

a) The original RFP language meets the needs of the Department.

b) Please see Page 14 of Attachment 0, Staffing Requirements.

c) Please see Page 14 of Attachment 0, Staffing Requirements.

d) The original RFP language meets the needs of the Department.

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vendor to share this

81 III-62-63 Section F.3.9.3 f Section F.3.9.3

RFP Text: Section F.3.9.3 f. Assist the Department in determining whether or not mandatory generic substitution should be enforced. The contractor must also survey retail pharmacies to identify the pharmacies that are unable to obtain the new generic drug within 21 days after the first date of shipment. The contractor must submit this information to the Department and provide any additional information as required by the Department to reach a determination.

RFP Text: Section F.3.9.3 Inform the Department as soon as possible but no later than 14 calendar days after the first date of shipment (from manufacturer to wholesaler or retailer) of the financial impact of enforcing mandatory generic substitution; . . .

Is the requested “first date of shipment” publicly available? Where is the information on what date a manufacturer ships product to wholesaler or retailer? It is our understanding that manufacturers may ship product in advance of the “launch date”?

Shipment could be less than 21 days from product launch. What New York requirement/law supports enforcement of pharmacies to comply with the survey requirement? How many pharmacies make up an appropriate “survey”? Would the state consider revising this requirement such that the survey would apply to wholesalers that support pharmacies in New York State?

The offeror should present its responses based on previous experience operating similar programs. The original RFP language meets the needs of the Department.

301 ATT I Attachment I; Contract Requirements; Page 22

Topic/Issue:

20. CONTRACT AMENDMENT

RFP Text:

20.2 If any change in the scope of work affects costs or the time required to perform other work, an equitable adjustment

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may be made in the payment provisions or delivery schedule, or both. Failure of the Contractor to agree to an equitable adjustment shall be considered a dispute and resolved under the provisions described in Section 17 above. Notwithstanding the previous language in this subsection, changes requiring system modifications shall be performed as part of the Evolution Process and shall not require a contract amendment or additional funding.

Discussion:

Coupled with a dispute resolution process that greatly favors the State’s interests, this clause will effectively allow DOH to dictate the price for any expansion of scope, as well as a contractor’s price for extension years.

Question:

We request that “Failure of the Contractor to agree to an equitable adjustment ….” not be considered a Dispute, but rather be the subject of continuing good faith negotiations until such time as the Department and the contractor reach agreement on the terms of any amendment.

The original RFP language meets the needs of the Department.


Topic/Issue:

25. TERMINATION

RFP Text:

25.1 In the event that the Contractor, through any cause, fails to perform any of the terms, covenants or promises of this Contract, the Department acting for and on behalf of the State, shall thereupon have the right to terminate this Contract by giving notice in writing of the fact and date of such termination to the Contractor.

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Discussion:

While the right to terminate fiscal agent contracts is not uncommon, the trigger should not be “any cause”. Additionally, there should be provisions for reimbursement to the contractor for lost investment of assets or costs to be incurred upon termination.

Question:

We request that this clause be modified to provide for a cure process prior to any termination.



Topic/Issue:

26. REMEDIES

RFP Text:

26.2 In the event of the Contractor's material breach, the Department may, with or without formally bidding: (i) purchase from other sources; or (ii) when the Department is unsuccessful after making reasonable attempts, under the circumstances then existing, to timely obtain acceptable service or acquire replacement product of equal or comparable quality, the Department may acquire acceptable replacement product of lesser or greater quality. Such purchases may, at the discretion of the Department, be deducted from the Contract quantity and payments due the Contractor.

Discussion:

Our concern with this clause is that a contractor is obligated to pay for “acceptable replacement product” which may actually conform to tighter specifications than those contemplated by the RFP. Furthermore, a contractor will become obligated to pay for the replacement product, regardless of how inefficient the entity that provides the replacement may be. This is especially

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troublesome in light of the stated intent to procure a replacement without formal bidding.

Question:

We request that this clause be modified to incorporate a reasonable cure period for the contractor to remediate any identified “material breach”, prior to the Department engaging another entity to perform the remediation activity. We further request that, in the event that the Department seeks outside services to perform any remediation activities, and seeks compensation from the contractor, that the contractor shall have the right to audit the modifications made and the related billings.

No, the original RFP language meets the needs of the Department.

304 ATT I Attachment I; Contract Requirements; Pages 25-26

Topic/Issue:

26. REMEDIES

RFP Text:

26.3 In any case where a question of non-performance by the Contractor arises, payment may be withheld in whole or in part at the discretion of the Department. Should the amount withheld be finally paid, a cash discount originally offered may be taken as if no delay in payment had occurred. Such amounts as they relate to Federal certification requirements may be deducted during the entire period that CMS certification is lacking for the MMIS system. Should Federal certification and the associated Federal funds subsequently be granted and provided retroactively, the Department will reimburse the Contractor for amounts withheld back to the date of certification.

Discussion:

The determination of non-performance does not reference specific criteria, a situation that could present a risk to a contractor. Amounts related to lack of CMS certification could be significant.

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Question:

We request that this clause be modified to state that, if there is a question of non-performance on the part of the contractor, a reasonable cure period will be allowed, and no monies will be withheld pending the resolution of the cure.

No, the original RFP language meets the needs of the Department. Regarding the cure period see RFP Section V.G.1.2.

305 ATT I

Attachment I 26. Remedies

RFP Text

6. The Contractor agrees to reimburse the Department promptly for any and all additional costs and expenses incurred for acquiring acceptable services, and/or replacement product.

Question

Please confirm that the Contractor will have an opportunity to cure prior to the Department’s assessing any costs for acquiring acceptable services, and/or replacement product.

An opportunity to cure can be found in the RFP Section V.G.1.2.


Topic/Issue:

26. REMEDIES

RFP Text:

26.6 The Contractor agrees to reimburse the Department promptly for any and all additional costs and expenses incurred for acquiring acceptable services, and/or replacement product. Should the cost and expenses incurred be less than the Contract price, the Contractor shall have no claim to the difference. The Contractor covenants and agrees that in the event suit is successfully prosecuted for any default on the part of the Contractor, all costs and expenses expended or incurred by the State in connection therewith, including reasonable attorney’s fees, shall be paid by the Contractor.

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Discussion:

The requirement for a contractor to reimburse the cost of “acceptable services” is a concern, since we have no ability to control another entity’s approach or inefficiencies. In addition, the definition of “acceptable services” is not stipulated in the contract, and may include items that were delivered according to specification, consistent with the process described in item 15.11 above.

Question:

We request that this clause be modified to incorporate a reasonable cure period for the contractor to remediate any issues identified, prior to the Department engaging another entity to perform the remediation activity. We further request that, in the event that the Department seeks outside services to perform any remediation activities, and seeks compensation from the contractor, that the contractor shall have the right to audit the modifications made and the related billings.

No, the original RFP language meets the needs of the Department. An opportunity to cure can be found in the RFP Section V.G.1.2.


Topic/Issue:

26. REMEDIES

RFP Text:

26.9 The Contractor shall be liable for the difference between the maximum allowable enhanced Federal Financial Participation (FFP) and the amount actually received by the State, including any losses due to delays in meeting the Department-approved schedule, in meeting Federal certification (retroactive to the beginning date of operations) or re-certification requirements. Damage assessments shall not be made until CMS has notified the State of its decision in writing.

Discussion:

This is a significant uncapped liability. In the eMedNY contract,

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a contractor has limits on liability for this requirement.

Question:

We request that the Department include a limitation of liability cap for this and all other potential liabilities under this contract in the amount of $25 Million to $30 Million.

This provision provides the parameters that limit the contractor’s liability. While undefined in amount it does effectively provide a cap on liability. The original RFP language meets the needs of the Department.

308 ATT J Various Attachment J is a critical attachment.

However, the location in the proposal where the State expects to find the completed Attachment J is not specified.

The proposal instructions for D.4 Scope of Work (Tab 4) imply that Attachment J should be placed behind the actual Tab 4 and prior to subsection D.4.1.

Please confirm that this is where the State wants bidders to place the completed Attachment J.

Completed Attachments J and P should be inserted at the conclusion of Tab 4 Scope of Work in offeror responses to this RFP.

309 ATT J Various The instructions for completing Attachment J states: “The table below lists the initial RFP mandatory requirements. The Contractor is required to acknowledge that they have read the requirement and agree that the requirement will be met by placing the word “agree” in the acknowledge column. Failure to agree to a requirement may be grounds to dismiss the Contractor from further evaluation.” Comparing Attachment J and P to the RFP, it was noted that there are requirements that may be in one source but not the other. The Facility requirements are an excellent example:

• RFP Section K (p. III-150 to 152) and the corresponding section from Attach P contain 7 questions

• Attch J (Tab 3.K) lists 174 detailed requirements for Facilities

To ensure that all bidders include the same elements in their

Attachment J reflects mandatory requirements and Attachment P reflects proposal requirements.

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solution, please confirm that the offeror’s solution for the R-MMIS and fiscal agent operation must incorporate the requirements in Attachment J and P. Also, should offerors include all requirements in Attachment J in their responses to the Proposal Requirements in the Statement of Work and Attachment P?

The offeror’s solution and implementation of the R-MMIS must include at a minimum all requirements in Attachment J and the proposed solution to the R-MMIS

The offeror’s response must address all proposal requirements in Attachment P.

310 ATT J Attachment J:

Data Governance

PP-147

PP-149

Page 7 of 146

Topic/Issue:

Logical Data Model

RFP Text:

1. Interface with, and take direction from the Department for all issues surrounding data. This includes but is not limited to:

b. Data Models; and

Discussion:

A logical data model reflects the business view of the data as is relevant to the MMIS and related systems. The physical data model is an operational view of the implementation of those business data rules and reflects requirements such as scalability, system performance, and the ability to meet SLAs. While it is reasonable to mandate change to the logical data model to ensure conformity of data formats across all R-MMIS related systems, mandated changes to the physical data model could place the contractor in a position to not meet performance standards.

Question:

We recommend this requirement be restricted to the logical data

The original RFP language meets the needs of the

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model, and not to the physical data model.

Department.

311 ATT J Attachment J: Data Governance

PP-152

Page 7 of 146

Topic/Issue:

Data Delivery to support the OHIP and support the MDW

RFP Text:

3. Deliver at a minimum daily all necessary data to support the OHIP metadata repository

Discussion:

N/A

Question:

Is the OHIP metadata repository (MDR) separate from the MDW MDR?

For the offeror to size network, storage and other hardware to support the metadata repository, what are the attributes of each type of object that are to be supplied to the MDR and to the OHIP Metadata Repository?

Yes.

The offeror should propose a solution that best meets the needs of the Department.

312 ATT J Attachment J

III.B Project Planning Tab

Topic/Issue:

Lack of Req ID

RFP Text:

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1. Take a proactive approach to analyzing and assessing the quality and accuracy of performance.

(after PP-20)

Discussion:

This requirement lacks an identification for mapping.

Question:

Request a REQ ID be assigned.

The Req ID is PP-20a.

313 ATT J Attachment J Tab. Project Planning Reqs PP-9

The RFP states: “Provide and adhere to a Project Management Plan (PMP) that is approved by the Department and based upon the proposed Project Management Methodology. The PMP must include all activities required to successfully complete all aspects of the R-MMIS. The PMP must:” C: Address both the technical and operational aspects of the project. Please provide a description of what operational components are required to be included in the Microsoft Project Plan.



The RFP states: “Provide and adhere to a Project Management Plan (PMP) that is approved by the Department and based upon the proposed Project Management Methodology. The PMP must include all activities required to successfully complete all aspects of the R-MMIS. The PMP must:” D: Address all the major sections of this RFP Throughout the RFP, the PMP appears to be described in singular terms, such as 1 MS Project Schedule. Our experience has shown that MS Project cannot handle the required number of tasks in a single MS Project file that are required to manage an MMIS of this size. Please clarify if a single MS Project file is required or multiple


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MS Project files can be submitted.


The RFP states: “Identify and record all tasks, deliverables and milestones associated with the project. The work must be decomposed into WBS that allow for accurate estimation of the work and resources required to complete the project. WBS must be no larger in granularity than the module level.” Regarding “WBS must be no larger in granularity than the module level.” It is unclear whether this requirement is directing vendors to ensure the WBS identifies work effort or tasks at a level no larger in work effort than a “module”. Also there is no clear standard for what compromises a ‘module’. To ensure all vendors provide the same level of detail in the Project Schedules, would DOH consider putting a maximum number of days or weeks that a single task can be? We have typically seen two weeks as such a maximum.



The RFP states: Make available online to Department and contractor staff the most current version of the PMP.” Please provide the number of non-vendor staff that we are required to provide licenses of MS Project to read the PMP.

Approximately 150.

317 ATT J Attachment J Data Conversion

IP-397

Page 22 of 146

Topic/Issue:

Legacy System Data

RFP Text:

6. Include a validation that all data from Legacy System has been converted;

Discussion:

N/A

Question:

Please provide a complete list of data that comprises the “Legacy System”.

Please refer to the Data Model and Technical Design Documents in the R-MMIS Procurement Library.

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The RFP states: “Define a set of quality objectives for the R-MMIS.” We did not see a current set of quality objectives in the Bidder’s library. Please provide the current quality objectives to understand the “as is” quality environment and a minimum set of quality objectives, to baseline all vendors.



The RFP states: “Provide State staff access to the quality management tool(s) used by contractor staff.” Please provide the number of State staff that will need access to the quality management tool.

Approximately 150.


The RFP states: “General research completed at the request of Management and/or State personnel.” To ensure that all bidders include the same elements in their solution, please provide the number of requests sent by State Management and/or State personnel to the incumbent fiscal agent and the hours or staff required for them to perform general research for the past 12 months.

The number of requests in the current systems environment may not be relevant to the number of requests in the R-MMIS because the operational and organizational environments will likely be different; nevertheless, the Department will require the contractor to “report monthly on its continuous review, and evaluation of" them in the context of Quality Management, as cited. For the past year, approximately 1,000 requests have resulted in the expenditure of approximately 4,000 contractor hours. This is not a guarantee of performance.


The RFP states: “Develop comprehensive data quality requirements;” We did not see a current set of comprehensive data quality requirements in the Bidder’s library. Please provide data quality requirements for all vendors to understand the “as is” quality environment, and a minimum set of data quality requirements to baseline all vendors.



The RFP states: “Provide State staff access to the scope management tool(s) used by contractor staff.” Please provide the number of State staff that will need access to the scope management tool.

Approximately 150.


The RFP states: “Provide and maintain a COTS product to document, track and manage issues and their resolutions identified during the project. The contractor must provide state staff with training and access to the COTS product.”

Approximately 150.

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Please provide the number of State staff that will need access to the issue management tool.


The RFP states: “Provide and maintain a COTS product to document, track and manage risks and their resolutions identified during the project. The contractor must provide state staff with training and access to the COTS product.” Please provide the number of State staff that will need access to the risk management tool.

Approximately 150.


The RFP states: “Provide State staff training and access to the configuration management tool(s) used to control software development.” Please provide the number of State staff that will need access to the configuration management tool.

Approximately 150.

326 ATT J, Tab III.B

Attachment J PP-34 to 40

PP-124 to 126

Please provide the most recent 12 Monthly Status Reports, from the incumbent contractor to the State, that summarizes Quality Management (as requested in PP-34 to 40) and Performance Management (as requested in PP-124 to PP-126)

A representative sample of these materials are included in the addendum to the R-MMIS Procurement Library.


The RFP States: “Develop, and provide access through the Web Portal to an Executive Management Dashboard that will display (upon-demand) the contractor’s operational performance metrics and provide the department management with the latest statistics regarding those metrics.” Please provide the past 12 months performance metrics and/or summary reports to help vendors understand the current performance environment and a minimum set of performance metrics to baseline all vendors.

Monthly Reports can be found in the addendum to the R-MMIS Procurement Library. However, the Department is open to a variety of solutions and the offeror should propose a solution that best meets the needs of the Department.


III.C Implement-ation Tab

Topic/Issue:

Duplicate Req ID

RFP Text:

IP-441 8. Following the Implementation Assurance Support tasks, the Contractor will create a Post-Implementation Support Results deliverable documenting the results. This deliverable

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will list all activities conducted by the Contractor and detail modifications that were made to the system in order for it to be ready for operation.

IP-441 1. Update the Incumbent Transition Support Strategy that details the offeror's approach to supporting transition activities with the incumbent MMIS, MDW and QA contractors.

Discussion:

Duplicate RED IDs

Question:

Request one or the other REQ ID be changed

REQ ID# 441a: 1. Update the Incumbent Transition Support Strategy that details the offeror's approach to supporting transition activities with the incumbent MMIS, MDW and QA contractors.


IP-138

12 of 145

RFP Text 10. Develop the Design Specifications Document detailing the Component-Level Specifications of data services that describe the various interfaces contained in the system as well as specifications for object-oriented components. Question The RFP uses two terms to describe a technical design deliverable, specifically: Design Specifications Document (Attachment J, IP-138 and Attachment L, page 4) and Technical Design Document (Attachment P, SDLC-7 and RFP page III-20 item d). Please either confirm these are one and the same or clarify the differences between them.

The Detailed Design Document and the Design Specifications Document are one and the same.


System Development

Topic/Issue:

State business operating procedures

RFP Text:

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IP-167

Page 13 of 146

14. Develop Business Operating Procedures, which must provide the details on how the new business processes are used for the various business units.

Discussion:

N/A

Question:

Will the Contractor be responsible for establishing/defining State business processes?

No, the offeror will be responsible for establishing/defining business processes required for the successful implementation and operation of the R-MMIS and Fiscal Agent activities.


Stress/ Performance Testing

IP-265

Page 17 of 146

Topic/Issue:

MARS/SURS

RFP Text:

…shall execute other existing R-MMIS processing …such as MARS/SURS

Question(s):

Since much of MARS/SURS certification and processing will be the responsibility of the MDW contractor will the Department provide guidance as to what activities of the MARS/SURS processes will be the responsibility of the MMIS fiscal agent?

The R-MMIS fiscal agent will be responsible for processing transactions and extracting data required to support the Medicaid Data Warehouse and MARS/SURS reporting.


BCDR-8

Page 137 of

Topic/Issue:

Data Retention Periods

RFP Text:

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146

e. Retention and storage of back-up files and software

Discussion:

The RFP does not mention data retention periods.

Question:

Currently eMedNY retains all pharmacy claims for 24 months; rate based claims from 2 - 9 years depending on claim type; ecommerce claims for 90 days; prior authorization for 5 years; member for 10 years past last eligibility and provider indefinitely. Do the current eMedNY operations retention periods hold true for the replacement system?

Yes. In addition rate based claims move to archive status and are retained forever to support retroactive rate adjustments.

333 ATT J Attachment J BCDR-13

136 0f 145

RFP Text

Back up on a daily basis all data files that reside on the multiple environments. These backups must be executed in such a way that any data set can be restored from the backup medium within five (5) minutes of the discovery and notification that a restoration is needed. On a weekly basis the Contractor will backup all databases and other data and store the backups at a secure off-site location;

Question

Please clarify that the “notification that a restoration is needed” is performed by the Contractor and (that) the 5 minute restore requirement is subject to complexity of recovery (e.g. Database) and size of data to be recovered (e.g. large files.) Also, please provide historical monthly averages over the past 12 months indicating the number of data set or file restore requests and SLA performance data for each request.

The original RFP language meets the needs of the Department

These materials are not relevant to the R-MMIS.

334 ATT J Attachment J RFP Text

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BCDR-14

136 0f 145

Provide a back up/recovery component comprised of a high capacity backup and recovery infrastructure for all data.

Question

Please confirm that the “recovery infrastructure for all data” is for R-MMIS data only and that a recovery infrastructure is not required for legacy eMedNY tape media. If recovery infrastructure is required for eMedNY tape media, will tapes be transferred to Contractor? If so, please provide tape library information to include: tape media format(s), quantity of tapes, and backup/recovery software version used to create each physical tape.

This is for all data within the R-MMIS.


BCDR-43

RFP Text

In the event the primary site becomes unavailable and/or the failover procedures cannot be successfully executed, the Department shall require the contractor to convert to the back-up site within twenty-four (24) hours of notification by the Department to do so.

Question

Please provide in hours the Recovery Point Objective (RPO) for the production R-MMIS environment.

Note: RPO is defined as the point in time to which data is restored following a disaster as defined in this RFP, e.g., RPO=24 hours.

Assuming the question refers to BCDR-38, the RPO for the primary computer facility is immediate. The RPO for the disaster recovery site is 24 hours.

336 ATT J, Tab III.C

Attachment J IP-401

How many years of history located in the files, tables, and document repositories are in scope for the data conversion?

All historical data is in scope for the data conversion.

337 ATT J, Tab III.C

Attachment J Tab Implementation

Tab III.C, lines IP-308,309,310 say: “Provide the capability to conduct testing using the raw transaction file and member data from the WMS’ CERT system.”

The CERT test environment is used to test between WMS

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IP-308, 309, 310 C.3.5

Please provide additional clarification regarding the scope of CERT testing. Please confirm that this is different from the CMS Certification activities that occur after the Functional Phase 1 Implementation phase.

baseline testing environment and the current eMedNY system to assure data validity before production.

Confirmed, the CERT test environment has no relationship to the CMS certification activities.

338 ATT J Tab III.C, requirement IP-401

Please provide the department’s document retention and destruction requirements per document type.

Please see addendum to the R-MMIS Procurement Library.

R-430-07136 Att1_Information.

ID 31: Question 338.

339 ATT J Tab III.C, requirements IP-22, IP-23

This requirement separately delineates a detailed design document and a technical design document as separate artifacts found within the proposed SDLC.

Please define the distinction between the content of these two documents.

The Detailed Design Document is written under the guidance of the Director System Design and Development by the Business Analysts and includes but is not limited to a detailed description of the business processes, workflow and system processes, data dictionary, data model, screen layouts, edits and other functions of the R-MMIS. This document is meant to be read by the business user or programmers.

The Technical Design Document is written under the guidance of the Technical Architect and includes but is not limited to a detailed description of the technical layers of the R-MMIS, the hardware and software components, the connectivity of the layers, the network architecture, how the R-MMIS relates to the MITA Technical Architecture, etc. This document is meant to be read by the state’s technical staff.

340 ATT J Tab III.C, requirement IP-265

Because the MAR and SURS functional areas are under the responsibility of the MDW contractor, should the following requirement be modified?

4. Set up test cases and scenarios that simulate a full day's worth of R-MMIS production processing. The test scenarios must represent typical situations. The Contractor shall demonstrate the ability to process the scenarios, from start to

The RFP requirement is amended to read: “Set up test cases and scenarios that simulate a full day's worth of R-MMIS production processing. The test scenarios must represent typical situations. The contractor shall demonstrate the ability to process the scenarios, from start to finish, within specified time limits. The contractor, as directed by the Department,

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finish, within specified time limits. The Contractor, as directed by the Department, shall also execute other existing R-MMIS processing, such as Management and Administrative Reporting System (MARS) and SURS.

shall also execute other existing R-MMIS processing, such as data extracts for the Medicaid Data Warehouse.”

341 ATT J Attachment J Tab III.C, Implementation IP-279

The following requirement from the Parallel Testing section of Attachment J will require substantial resource commitments from the Department and the incumbent (as well as the R-MMIS contractor). For instance, a great deal of effort is required to run and support legacy system parallel cycles, and to research and resolve issues as they arise.

5. Support the completion of a comprehensive Parallel Testing in which users test all MMIS functions in a production-like controlled and stable environment, including but not limited to, converted files, proper functioning of edits, audits, and business rules; the accuracy of claim records payment and file maintenance; and the format and content of all system outputs, including outputs from reporting functions, User Manuals, forms, procedures, and business processes.

Can the Department describe how this requirement will be supported by knowledgeable incumbent and State staff for each MMIS business area throughout the six month Parallel testing phase?

The Department and the incumbent will furnish adequate staff during the parallel testing phase. The offeror should propose a solution that best meets the needs of the Department.

342 ATT J Attachment J Tab IIII.C Implementation IP 277

IP 277: Certify the environment is complete and ready for acceptance test execution. This requirement is listed under Parallel Testing but appears to reference UAT. Please clarify.

The requirement refers to acceptance test execution that is part of parallel testing prior to implementation.

343 ATT J Attachment J Tab Implementation IP-439

In Attachment J, tab III.C, we see the following requirement: 6. Support the parallel operations of the R-MMIS for not less than three (3) billing cycles. Conduct an operational readiness review including an assessment of required thresholds defined in Attachment P Performance Standards and Reporting. Please elaborate on the State’s expectations for activities associated with parallel operations as used in the context of the requirement cited above, and clarify how these may or may not

Parallel operations will take place during the entire 6 month parallel testing phases as various aspects of the system are

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be different from activities required during the six-month parallel testing phase. Please confirm our assumption that parallel operations takes place during the final stages of the six-month parallel testing, prior to Production Go-Live.

tested.

A comprehensive parallel test will be undertaken during the final stages of the six-month parallel testing.

344 ATT J Attachment J Tab Implementation IP-440

In Attachment J, tab III.C, we see the following requirement: 7. Provide Implementation Assurance Support for a period of three (3) months following the completion of parallel operations and approval to proceed to full implementation based on thresholds and acceptance criteria defined in Section III.O Performance Standards and Reporting, whichever is longer. The purpose of Implementation Assurance Support is to ensure the optimal processing of the R-MMIS, provide production monitoring, provide emergency maintenance, and provide assistance in computer resource management and data resource management activities. Offerors must provide a detailed description of their approach for providing implementation assurance support, and how they will validate that the system meets the threshold criteria delineated in order to minimize the amount of time required for this task. We understand this requirement is to provide three months of Implementation Assurance Support following the agreed-to go-live date for the R-MMIS. If the contractor is not able to meet the Performance Standards and Reporting requirements in Section III.O by the end of the three month period, assurance support must continue until the Performance Standards are met. Please confirm that this understanding is accurate. Also please clarify that penalties for not meeting Performance Standards will not be applied during this post-implementation assurance timeframe.

The understanding is correct.

The Department will not prospectively waive any performance requirements. As stated in the RFP, penalties will be assessed at the Department's discretion.

345 ATT J Attachment J, OAS-20

140 of 145

RFP Text

5. Will submit a Staff Skills Matrix for each person filling a Key Staff position. The Matrix which is included in Attachment M summarizes relevant experience of the proposed staff

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RFP Page


Question

Please confirm that the Staff Skills Matrix (not provided in Attachment M) is the Qualifications and Experience Chart in Attachment O.

They are one and the same.


OPR-194

44 of 145

RFP Text

Written notices to members and prescribers regarding their hearing rights following a pharmacy PA request denial as directed by the Department. Notices must be written in English and other required languages in accordance with Department-approved procedures and content.

Question

Please clarify the languages covered in the ‘other required languages’ portion of the requirement.

Notices are required to be written in English and Spanish.

347 ATT J, Tab III.F

Attachment J OPR-14

Please provide how many total calls are completed in a month using only IVR and ARU automated, self-service transactions?

Please note this is actual current volumes and may not provide a good basis for estimating future activity.

Total number of calls to the ARU: 244,462

Total number of calls to the IVR: 103,097 348 ATT J,

Tab III.F Attachment J OPR-14

Please provide the average call handle time for the automated, self-service transactions. Please provide a breakdown of the call handle times by transaction.



ID 6: Question 348.


Attachment J OPR-15

Please provide how many total calls are connected to and answered by a live agent per month for the most recent 12 months.



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RFP Page


ID 7: Question 349.


Attachment J OPR-15

For staff planning purposes, please provide a breakdown of the number of calls that reach each functional area defined in the current state.

The offeror’s question is not clear enough to provide a definitive response.


Attachment J OPR-15

Please provide the average call handle time for each functional area defined in the current operations.



Attachment J OPR-15

Please provide the past 12 monthly Call Management Reports with a breakdown of the call volume by functional area, by hour, and by day of the week, with all typical call statistics (such as hold time, call handle time, after work time, speed to answer



ID 8: Question 352.


Attachment J OPR-15

What is the current first call resolution percentage by functional area?



Attachment J OPR-15

Please provide how many minutes of outbound calls are made per month. Please provide a breakdown of outbound calls by functional area.

This information is not available at this time.

355 ATT J Tab III.F, requirement OPR-15

Which languages are required to be spoken by the IVR and ARU?

The IVR and ARU must include English and Spanish options during all hours of operation.

356 ATT J Tab III.F, requirement, OPR-15

Which languages are required to be spoken by human agents? If other than English, please provide the volume of non-English-speaking calls per month.

The eMedNY Call Center automated menu of options is in English, but the contractor has six service representatives who speak Spanish. The Call Center receives an average of 280 Spanish calls per month. Please note this is a current volume and may not provide a good basis for estimating future activity.

The call center must include English and Spanish options during all hours of operation. The offeror should provide access to translation services to accommodate other languages. Additionally, the needs of the hearing impaired

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RFP Page


must be addressed. Volume of non-English speaking calls per month is not available at this time.

357 ATT J Attachment J, OPR-57

TOPIC/ISSUE:

PA Documents Failing Screening Criteria

RFP TEXT:

1. Receive, review for completeness and process for determination hard copy and fax prior approvals and supporting materials. Transactions failing the completeness review must be returned to the submitter without further processing.

DISCUSSION:

Currently PA documents failing screening criteria require that the original be returned to the submitter and a reject letter be manually created. The process is very labor intensive. An imaged-based process would provide greater detail as to why a submission was rejected and would be more efficient.

QUESTION(S):

Do the originals need to be returned or can an image be substituted in its place?

This level of detail will be part of DDI. For example, certain documentation submitted with a request that is rejected, such as radiographic films, must be returned as originals.


TOPIC/ISSUE:

Method of Returning TOA Applications Failing Screening Criteria

RFP TEXT:

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QUES #

RFP Page


2. Receive, review for completeness and process hard copy and fax Threshold Override Applications (TOAs) and cancellations. Transactions failing the completeness review must be returned to the submitter without further processing.

DISCUSSION:

Currently TOA documents failing screening criteria require that the original be returned to the submitter and a reject letter is manually created. The process is very labor intensive. An imaged based process would provide greater detail as to why a submission was rejected and would be more efficient.

QUESTION(S):

Do the originals need to be returned or can an image be substituted in its place?

This level of detail will be part of DDI. Certain documentation submitted with a request that is rejected, such as radiographic films, must be returned as originals.


TOPIC/ISSUE:

Method of Return for Faxed Documentation Failing Screening Criteria

RFP TEXT:

1. Receive, review for completeness and process hard copy and fax applications for: a. Trading Partner and Security Agreements; b. Electronic Transmitter Identification Numbers (ETIN); c. Electronic Funds Transfers (EFT); and, d. Web Portal Users Ids. Transaction failing the completeness review must be returned to the submitter without further processing.

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RFP Page


DISCUSSION:

These categories of documents are not currently received via fax. Typically hard copy documents would be returned to the submitter.

QUESTION(S):

If the contractor receives a document via fax that fails the completeness review, is it a requirement to fax it back to the submitter or can it be mailed?

***Please note that this question applies to any document received via fax.

This level of detail will be a part of the DDI in light of legal and programmatic requirements, efficiency and ease of use for the provider community.


Will the state clarify that bank reconciliation is completed within ten (10) workdays of the end of each reporting month depending on the receipt of appropriate input (for example bank statements and/or State data necessary to complete the reconciliation)?



Attachment J OPR-176

Please provide volume information for notifications, publications, and related materials produced monthly and yearly.






Please provide volume information for all inbound and outbound mail per month and per year.






Please provide a breakdown of the mail received by PO Box or category.

This information is not relevant to this procurement.

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QUES #

RFP Page


364 ATT J Attachment J Tab III.F, requirement OPR-283

The requirement states: Support and monitor the periodic archiving of selected information based on criteria and schedules specified by the Department.

Please provide the current criteria and schedules for selecting and archiving information.

Currently non-lifetime claims are archived after 6 years, 9 years for inpatient and nursing home, prior authorizations after 5 years, and the capability for eligibility transactions after 10 years. However, the criteria and schedules are subject to change based on Department policy requirements. The offeror should propose an archiving solution that best meets the needs of the Department.


The requirement states: Support and maintain all hard-copy forms, attachments, and other documents in accordance with State retention requirements and dispose of in accordance with Department-approved procedures.

Please provide the number of forms, attachments, and other documents to be archived. Please provide the current retention and disposal procedures.





TN-10

141 of 145

III-158

RFP Text

11. Training will include "at elbow” training in central locations identified by the Department, which may include contractor field offices, LDSS offices, or regional training centers.

Question

Please provide an approximate number of locations.

The number of locations is dependent upon the contractor’s training plan. The offeror should propose a solution that best meets the needs of the Department.

367 ATT J Tab III.G, requirement, TP-60

Please confirm that turnover is considered complete when the Department or successor contractor has initiated their Operations Phase.

Turnover is considered complete when all activities included in the Department approved Turnover Plan have been completed and approved by the Department.

368 ATT J Attachment J, Tech Systems Architecture

TSA 132 tells contractors to provide “Provide low bandwidth versions of State-specified pages for easy access by providers with mobile and wireless web access.”

Please provide the requirements for the state-specified pages or

The pages the Department would specify are dependent upon the design of the R-MMIS. The Department will specify

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RFP Page


provide a list of state-specified pages for this requirement. the pages after the design is complete.

369 ATT J Attachment J Tab Tech System Arch TSA-5

The requirement in TSA-5 states: “5. Support the ability to develop and test a minimum of three (3) concurrent multiple releases of the R-MMIS.”

Please further clarify this requirement:

• Will this requirement require a new environment with full sets of data for each one?

• Please define the types of support required to meet this requirement.

No.

The Department expects the contractor to develop innovative solutions that best meet the needs of the Department.


Technical and System Architecture

TSA-13

Page 55 of 146

Topic/Issue:

Geocoding format and standards

RFP Text:

13. Assign standard geographic coding (commonly known as geocoding) to accommodate use of the transactions by commercial geographic information systems (GISs) to all transactions processed.

Discussion:

N/A

Question:

Please describe what transactional information or location should be used to assign the geocoding information to each transaction.

Please specify the geocoding format and standard to be used.

The transactional information or location is dependent on the design of the R-MMIS and will be identified during the JAD sessions.


371 ATT J Attachment J Topic/Issue:

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RFP Page


Environment Requirements

TSA-26

Page 56 of 146

SIT Data Volumes

RFP Text:

a. Mirror production in hardware, software stack, and data volumes in order to perform full-scale system integration testing.

Discussion:

N/A

Question:

In regard to ‘production… data volumes’; does this mean a unique copy, per individual environment of all rows of all tables including the full claims volumes based on the current retention of Pharmacy Claims for 24 months; Rate Based Claims from 2 - 9 years depending on claim type; e-Commerce for 90 days; Prior Authorization for 5 years; Financial for 6 weekly cycles, Member information including TPL for 10 years past last eligibility and Provider information indefinitely?

The environment must be able to access a copy of production data which is of sufficient volume to perform the functions of the environment.



TSA-31

Page 56 of 146

Topic/Issue:

Volumes for Test Systems – Question #1

RFP Text:

a. Mirror production in hardware, operating software stack, and data volumes and house the application code prior to its promotion to production

Discussion:

N/A

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RFP Page


Question:





TSA-47

Page 56 of 146

Topic/Issue:

Provider Test Input Channels

RFP Text:

c. Have the capability to test provider input from various channels

Discussion:

N/A

Question:

Please define the ‘various channels’.

Any and all channels necessary to support the proposed R-MMIS.

Over the life of the contract new telecommunications devices will be developed and brought to market. If the R-MMIS requires these devices, the contractor must support these devices.



Topic/Issue:

Volumes for Test Systems – Question #2

RFP Text:

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RFP Page


TSA-51

Page 57 of 146

a. Mirror production in hardware, software stack, and data volumes in order to perform full-scale system testing. b. Allow authorized Department testers to continue to simulate various conditions for transactions using data from production and full raw transaction file input

Discussion:

N/A

Question:




Please provide a breakdown of the electronic storage subsystems and their current capacity utilization by storage tier (for example very high speed/mission critical, less frequently accessed data, archival backup, disk-to-disk backup) and system function (for example database, images, data files, and reporting). • Please provide the hard disk space used by the eMedNY

database for claims processing and history in the production environment.

• Please provide the hard disk space used by data stored in the Filenet system and any other imaging, content, or document management systems that may exist in the production environment.

• Please identify any other application that contains more than 100GB of data. For each of these identified applications, please provide the respective hard disk space used in the production environment.

• Please provide a list of all COTS packages and versions


R-430-07137 Att1_Information_2.

ID 44-47: Question 375.

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RFP Page


used by the current eMedNY vendor.


How many electronic backup tapes exist and what types of types are stored at Iron Mountain?



ID 3: Question 376.


HW/OS Components

TSA-62

Page 57 of 146

Topic/Issue:

Open Storage Platform – definition and example

RFP Text:

4. Ensure storage of data takes place on an open storage platform;

Discussion:

N/A

Question:

Please provide a clear, detailed definition and provide an example of an ‘Open Storage Platform’.

Open storage refers to storage systems built with an open architecture using industry-standard hardware and software.


HW/OS Components

TSA-63

Page 57 of 146

Topic/Issue:

Open Server Platform – definition and example

RFP Text:

5. Ensure processing of data takes place on an open server platform;

Discussion:

N/A

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RFP Page


Question:

Please provide a clear, detailed definition and provide an example of an ‘Open Server Platform’.

Open server platform refers to servers built with an open architecture using industry-standard hardware and software.


TSA-72

57 of 145

RFP Text

The Contractor shall order, arrange for the installation and coordinate the maintenance of the telecommunications lines between the Contractor and providers, the local districts, the Department, the MDW, and other State users

Question

Please provide a list with addresses and telephone numbers of the locations at which the contractor is required to order, install and maintain telecommunications lines—including disaster recovery sites.

The contractor will need to install:

Two (2) lines to the NYeNET. This will accommodate LDSS and other State agencies;

Two (2) lines to the MDW primary site in Corporate Woods Albany NY; and,

Two (2) lines to the MDW DR site in Sterling Forest NY.


Network Components

TSA-72

Page 57 of 146

Topic/Issue:

Telecommunications Lines - general

RFP Text:

2. The Contractor shall order, arrange for the installation and coordinate the maintenance of the telecommunications lines between the Contractor and providers, the local districts, the Department, the MDW, and other State users

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RFP Page


Question:

Is it the Department’s intent to no longer use NYeNET as the backbone between the MMIS and State facilities/organizations?

Who is responsible for the recurring costs of the telecommunications lines?

Must the telecommunications lines be FIPS 140-2 compliant?

What are the redundancy requirements?

Please provide a detailed list of all demarcation points, circuit speeds and type of circuit to which connectivity will be required.

What specific types of telecommunications lines are required to be provided to Medicaid Providers, and what are the numbers and types of lines to be provided by the contractor?

Please provide a specification for the telecommunications required to support the MDW.

No. The Department will use the NYeNET. All connections between the LDSS and the R-MMIS will be through the NYeNET.

The contractor will need to supply two lines connected to the NYeNET. The contractor will be responsible for all recurring costs of telecommunication lines throughout the term of the contract.

Yes.

The contractor must provide a telecommunications infrastructure that is capable of supporting all RFP requirements and meeting all service levels found in this RFP.

The current network design is not relevant to the R-MMIS. The Department expects the contractor to develop new and innovative solutions to meet the Department’s objectives. The offeror should provide a network design in its proposal based upon its proposed R-MMIS and that best meets the Department’s requirements.

.

381 ATT J, Tab III.H

Attachment J TSA-72

Please provide a Network Architecture/Topology diagram that shows the current telecommunications in place between all of the stakeholders mentioned in the requirement below:

2. The Contractor shall order, arrange for the installation and coordinate the maintenance of the telecommunications

The Department will use the NYeNET. All connections between the LDSS and the R-MMIS will be through the NYeNET. The contractor will need to supply two telecommunication lines connected to the NYeNET

The current network design is not relevant to the R-MMIS.

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RFP Page


lines between the Contractor and providers, the local districts, the Department, the MDW, and other State users

The offeror should provide a network design that best meets the needs of the Department.


Network Components

TSA-72a

Page 58 of 146

Topic/Issue:

Line must have a minimum transfer capacity of 1 GB.

RFP Text:

“…a dedicated telecommunications line between the Contractor’s data centers and the MDW data center.”

Discussion:

There is a requirement to support data lines from eMedNY to MDW and to the MDW DR site.

Question(s):

Does this sole requirement provide the needed connectivity between the R-MMIS, the MDW and other R-MMIS stakeholders?

Is there any other connectivity required by the R-MMIS for the MDW?

Who is responsible for the recurring costs of the telecommunications lines?

Must the telecommunications lines be FIPS 140-2 compliant?

What are the redundancy requirements?

No.

See response to question 379.

The contractor is responsible.

Yes.

See response to question 379.


Network

Topic/Issue:

35


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RFP Page


Components

TSA-77

Page 58 of 146

POTS Lines

RFP Text:

2. Provide a dedicated POTS line at each facility for dial-up access into the network from Albany, New York;

Discussion:

N/A

Question:

Please list each facility and location for access.

The current network design is not relevant to the R-MMIS. The offeror should provide a network design that best meets the needs of the Department.

384 ATT J Tab III.H, requirement TSA-79

Please provide a description and identify capacity and utilization statistics for each of the network circuits.

The current network statistics are not relevant to the R-MMIS. The capacity and utilization of the telecommunication lines is dependent upon the network design of the proposed R-MMIS.

The Department expects the contractor to develop new and innovative solutions to meet the Department’s objectives. The offeror should provide a network design that best meets the needs of the Department


Network Components

TSA-79

Page 58 of 146

Topic/Issue:

Network support for users

RFP Text:

4. Provide network support for the R-MMIS which must, upon implementation, be able to support as many as twelve-hundred (1200) users, with an estimated two-hundred (200) users accessing the system concurrently. The network also must be able to allow for ten (10) percent growth per year in the total

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QUES #

RFP Page


number of users and concurrent users;

Discussion:

N/A

Question:

Please describe the types of network support the offeror will be required to provide.

Please describe who the users are and what their locations would be.

The contractor must provide phone support for network problems and device support for any of its devices on the network.

Users include but are not limited to providers, Department staff, other state agencies, LDSS staff, and Department contractor staff located predominately throughout the state of New York.


Network Components

TSA-80

Page 58 of 146

Topic/Issue:

Secure Data Lines

RFP Text:

5. Establish agreements with telecommunications network vendors to install secure data lines to its data center;

Question:

Please define ‘secure data line’ in detail.

Who is responsible for the costs of the secure data lines?

Please provide a telecommunications specification for this requirement.

The network must allow the Department to pass PHI data to its business partners in a secure manner consistent with all Federal and State requirements.

The contractor is responsible for all network costs.


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RFP Page



TSA-85

58 of 145

RFP Text

Ensure that the Department or any third-party authorized by the Department is able to directly access over the network, without Contractor intervention, any of the Department equipment located in the Contractor’s data center.

Question

Please specify the type of Department equipment (e.g., Network routers, switches, and Servers) and the purpose for the direct access, e.g., whether this is for read-only access of network equipment parameters?

Any and all network equipment or servers owned by the Department. The access is necessary for any or all tasks necessary, such as, but not limited to, auditing or diagnosing equipment performance.


TSA-85

58 of 145

RFP Text

Ensure that the contractor, Department staff, other state agencies, LDSS and Department contractor staff have access capability through the NYeNET to access all of the R-MMIS environments defined in this RFP;

Question

Please provide the access and security requirements for connection of the R-MMIS to the NYeNET. Please provide a network diagram for NYeNET.

See the documents in the addendum to the R-MMIS Procurement Library entitled “NYeNet e-port overview” and “NYeNet overview 2010”.


Attachment J TSA-86

Referencing the requirement below, please provide a Network Architecture/Topology diagram that explains NYeNET.

11. Ensure that the contractor, Department staff, other state agencies, LDSS and Department contractor staff have access capability through the NYeNET to access all of the R-MMIS


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RFP Page


environments defined in this RFP


Network Components

TSA-86

Page 58 of 146

Topic/Issue:

NYeNET user access

RFP Text:

11. Ensure that the contractor, Department staff, other state agencies, LDSS and Department contractor staff have access capability through the NYeNET to access all of the R-MMIS environments defined in this RFP;

Discussion:

N/A

Question:

Is it the Department’s intent to have all State agencies listed access the R-MMIS via the NYeNET and/or the Offeror network referenced in TSA-72?

LDSS and State agencies will access the R-MMIS through the NYeNET.


Network Components

TSA-89

Page III-68

Topic/Issue:

Software development for telecommunications

RFP Text:

14. Develop software as needed to support new telecommunications features, configurations, and devices;

Discussion:

N/A

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RFP Page


Question:

Please provide an example of the type of software the Department anticipates the Offeror will need to develop.

Over the life of the contract new telecommunications devices will be developed and brought to market. If the R-MMIS requires these devices the offeror should support these devices.


Please provide an example of telecommunication features, configurations, and devices that require new software development.

Over the life of the contract new telecommunications devices will be developed and brought to market. If the R-MMIS requires these devices the offeror should support these devices.


TSA-92

58 of 145

RFP Text

Provide a network server that can be shared between Department and Contractor staff

Question

Please describe the type of server required, the connectivity required, and the primary purpose/use of the server.

Does this server require backup, business continuity, and/or

The server shall have the following minimum configuration:

Rack Mountable Server with Rack, Quad Core CPU’s, 16 – 32 GB RDIMM Memory, Internal DVD+/-RW, SATA Internal, Raid Controllers configured for System and Storage Hard Drives, 1 – 2 TB Internal Storage (Drive type to be determined), External Drive Shelf for Near Line Data Backup and Storage, 5 – 8 TB External Storage (Drive type to be determined), Dual Port 10 Gbe NIC, Embedded Server Management, Slide Ready Rails with Cable Management, Uninterruptable Power Supply; 2700 Watt 3U, 120 Volt, with L5-30P, 2m Cord, Symantec Backup Exec 2010 Server Suite w/ Bare Metal Recovery.

The server requires backup, business continuity, and DR services.

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RFP Page


DR?

Is there a specific location requirement for the network server?

This server will be connected to the LAN and provide access for the Department’s staff and contractor staff to share files and documents, project plans and administrative documents.


TSA-93

58 of 145

RFP Text

Provide access to the R-MMIS for remote users, through a variety of communication channels and protocols.

Question

Other than IP, please specify what protocols are required

Any and all protocols necessary to support the proposed R-MMIS.


TSA-94

58 of 145

RFP Text

Provide access to the R-MMIS for external computer systems, through a variety of communication channels and protocols.

Question

Other than IP, please specify what protocols are required

Any and all protocols necessary to support the proposed R-MMIS.


TSA-96

59 of 145

RFP Text

Support the VeriFone terminals custom software

Question

Please define the complete range of contractor support for the VeriFone terminals.

The contractor will be required to support and distribute the software.

POS devices are provided by OMIG to mandated swipers through contracts with the current fiscal agent. The OMIG will pursue the necessary contracts to continue to supply devices for providers they so designate.

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RFP Page


POS devices used by providers not designated as mandatory swipers by the OMIG are currently purchased by the individual providers from the Fiscal Agent, or were previously provided by the Department.

There are currently approximately 12,000 POS devices.

Custom software provided by the fiscal agent is installed on each device. Modifications to that software are occasionally required to respond to new Department policy and operational initiatives and must be pushed by the contractor to providers as a part of the modification project. Although no regular update is defined, the contractor is required to refresh POS device software on demand in case of individual POS failure or corruption.


What is the minimum DPI requirement for scanning paper documents?

The scanned documents should be of sufficient resolution that a worker can comfortably read the document. The offeror should propose a solution that best meets the needs of the Department.


Attachment J TSA-204

Please provide how many documents are scanned or captured per month into the imaging/document repositories.





Attachment J TSA-225, TSA-226

Please provide how many historical documents or images exist in the document repositories. What is the total size in gigabytes for the document repositories? Please provide document repository monthly growth for the past 3 years (in gigabytes).



ID 28-30: Question 399.


TSA-284

RFP Text

f. Involve Computer Telephone Integration (CTI) to provide personalized routing and work-object handling

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RFP Page


65 of 145 based upon identifiers received from the caller regarding language and inquiry area and to produce reports on both electronic and voice transactions;

Question

Please clarify if there are multi-lingual requirements for the call center. If there are, please indicate the languages to be supported.


The call center must include English and Spanish options during all hours of operation. The contractor must provide access to translation services to accommodate other languages. Additionally, subject to Federal and State requirements, the needs of the hearing impaired must be addressed. Volume of non-English speaking calls per month is not available at this time.


TSA-286

65 of 145

RFP Text

g. Provide multiple language options and services for hearing impaired;

Question

Please clarify which language options are required. Please clarify the “services” required for the hearing impaired.


The call center must include English and Spanish options during all hours of operation. The contractor must provide access to translation services to accommodate other languages. Additionally, subject to Federal and State requirements, the needs of the hearing impaired must be addressed. Volume of non-English speaking calls per month is not available at this time.


Web Portal

Topic/Issue:

Customization bundling/unbundling of provider codes

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RFP Page


Requirements

TSA-135

Page 60 of 146

RFP Text:

14. Provide the functionality to fully customize any combination of bundling/unbundling of service procedure codes via a web portal using a COTS rules-based engine.

Discussion:

N/A

Question:

Please define ‘bundling/unbundling of service procedure codes’.

Bundled procedures occur when the provider submitted a multi line claim that contains procedure codes that the Department has determined are included in another service. As a result, they are not individually payable. Unbundled procedures are when the provider submits a "global" code which is considered all-inclusive, but the determination has been made to retain the various pieces in history. This could be for reporting or history edits. There are specific remittance requirements associated with both of these items.


Web Portal Requirements

TSA-138

Page 60 of 146

Topic/Issue:

Provider messaging formats

RFP Text:

17. Provide the ability for Department to staff send and receive electronic messages to specific provider

Question:

What type/format of electronic messaging is required (email,

Message types include but are not limited to e-mail, broadcasts, GSM, SMS, etc.

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RFP Page


sms, etc.)?

404 ATT J, Tab III.I

Attachment J Security

Network Security: What are the supported methods of interfacing with the States NYeNet, HSEN, and the HealthCom Network?

What data is exchanged with these interfaces?



Attachment J Tab Sec Priv Confidentiality SPC-39

Attachment J, SPC_39 states: “The Contractor’s Network Architecture and all proposed network hardware and software must be compliant with. Security requirements for Level 3 cryptographic module as defined in Section 5131 of the Information Technology Reform Act of 1996 and further defined FIPS publication 140-2 issued May 25, 2001” 1) Would the State consider exempting devices in physically

secured locations that connect to other devices wholly owned within the secured area from this requirement?

2) If the answer is no, will the State grant exemptions for

device categories where no NIST approved FIPS 140-2 Level 3 products exist?



406 ATT J Attachment J Tab R-MMIS Functional Reqs FPH-1 (1.j) FPH-3 (3.d)

Requirements FPH1 (1.j) and FPH-3 (3.d) refer to Restricted Transportation Information and storing and displaying this information. The eMedNY Technical Design describes that this data is used by the Prior Authorization subsystem to approve or deny transportation PA’s and that the data is available to other eMedNY subsystems when needed. Other than the described use by Prior Authorization, how else is this data used?

Data is available for review by authorized users.

407 ATT J Attachment J Tab R-MMIS Functional Reqs

Please explain the difference between the requirement to: a. Delete card

(a.) Delete card is when WMS sends a delete; eMedNY flags

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FPH1-18 b. Delete all cards the card for deletion.

(b.) Delete all cards is when WMS sends a delete all, all cards are flagged for deletion and new cards are sent to replace them. This process is done in a resynch.

408 ATT J Attachment J Tab R-MMIS Functional Reqs FPH1-19

What information is currently transmitted today on an initial Card Swipe? What information is stored on the magnetic stripe?

A card swipe initiates an eligibility or service authorization transaction, resulting in an x.12 270 or x.12 278 request. Information about the menu options and associated data entry accompanying a card swipe can be found in the MEVS manual located on eMedNY.org.

Primary Account Number (PAN), Expiration Date, Service Code and CAV (Card Authentication Value).


What information is expected to be displayed on the cards? Please refer to the MEVS Manual on the eMedNY website.


Please confirm that when a card is first swiped, this action voids the previous card so that it can no longer be used by the member. Please clarify, if the void of the card is immediate. If not, how many days are allowed before the void occurs?

Confirmed.

The Department notifies the issuing entity, OTDA, when a new card is first used, so they may take the appropriate action. OTDA sends the Department status information nightly regarding cards that have been voided.


FPH1-40

(J.1.2.1.1.1d/page III-93)

RFP Text

2. Produce and transmit the Medicare Modernization Act (MMA) file to CMS on a schedule to be defined by the Department. This file represents the New York State dual eligible and prospective dual eligible population.

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76 of 145

Question

What is the current schedule defined by the Department?

The Department sends a full file on the third Monday of the month and an incremental file each Thursday of the month.

412 ATT J Tab III.J, requirement FPH1-42

4. Process and maintain Medicare data from the MMA file as specified by the Department including:

Medicare Part A and Part B: verify accuracy of current Medicare data and update data according to Department guidelines;

Medicare Part C: using the MMA return data and the plan information create commercial insurance according to Department guidelines; and

Medicare Part D: must maintain member Medicare Part D information, including but not limited to:

Carrier Name;

Carrier Plan Code;

Enrollment period;

Benefit Package;

Low Income Subsidy (LIS); and

Employer Retirement Drug Subsidy (must maintain member Employer Retirement Drug Subsidy status).

In reference to Part B above, what is meant by “create commercial insurance?”

Medicare Part C information is stored in the Commercial Insurance tables not the Medicare tables. A Part C record needs to be created as Commercial Insurance.


Attachment J Tab R-MMIS Functional Reqs FPH1-61

FPH1-61 states the following:

11. Automatically create and close Medicare Part C records

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based on Department rules.

Please confirm that this requirement is for the system to automatically match existing Medicare/Medicaid dual eligible members into Medicare Advantage plans and auto-enroll them.

The requirement is to compare the Medicare Part C information that CMS provides through the Medicare Modernization Act (MMA) and the information in the R-MMIS, and either add the coverage if it is not on the R-MMIS or end-date it if the coverage on the R-MMIS shows as being open-ended.

413a ATT J, Tab III.I

Attachment J FPH1-61 “11 Buy-In

FPH1-61 states “11. Automatically create and close Medicare Part C records based on Department rules.” CMS provides Medicare C coverage data in the MMA and TBQ exchange files. Typically, changes to Medicare C coverage are initiated by CMS. Please provide what other Department rules may initiate the creation or closure of Medicare Part C records?

Medicare Part C plans, with the exception of certain plans identified by the Department (e.g., PACE and CMS demonstration projects), are loaded into the Third Party Data tables. Plan ID for plans that are not loaded (e.g., PACE and CMS demonstration projects), are maintained in a separate table for reference. Part C plans are currently identified in system by the Contract ID number assigned to them by CMS, as well as a Medicare Advantage Indicator. The Medicare Advantage Indicator further identifies if the plan is either a traditional Part C plan or a Cost or Health Care Pre-Payment Plan (HCPP). A standard scope of benefits is loaded for Part C Plans; Vision and/or Dental coverage, if covered by the specific contracts, are included when available.


Attachment J Member Eligibility Verification FPH1-64

2. Support all channels approved by the Department for eligibility verification transactions including but not limited to: • Call Center Services using IVR technology and Automated

Response technology • POS (Point of Service) device including Verifone • Direct connection including VPN or leased line • Batch transmission (such as FTP and SOAP) • Provider web portal Are the POS transactions in a proprietary format?

No, POS transactions conform to x.12 270 and x.12 278

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standards.


FPH1- 75

80 of 145

RFP Text

6. Provide the capability to mass enroll Managed Care network providers based on files received from Managed Care Plans or other sources as designated by the Department.

Question

Please define what is meant by “Mass Enroll" in this context.

Does this refer to conversion of data from the legacy system?

Is the mass enrollment to be implemented prior to system startup or staggered throughout the life of the implementation?

Would it be all at once (right before startup)?

Would the X12 274 Provider Information transaction be involved?

Mass Enrollment is the capability to migrate provider enrollment data from Managed Care Plans to the R-MMIS.

No.

This is an operational activity to be performed on an interval determined by the Department throughout the term of the contract.

No.

No.


FPH1-89

81 of 145

RFP Text

4. Perform electronic verification with all entities involved in provider enrollment (to the extent these entities support electronic interfaces). These entities include but are not limited to: CAQH (Council for Affordable Quality Health Care); Drug Enforcement Agency (DEA); Social Security Administration (SSA); Online Survey, Certification and reporting System (OSCAR) CLIA; HHS Office of the Inspector General (OIG) Sanction List; State Education Department (SED); Pharmacy Board; New York State Board of Medical Examiners; Internal Revenue Service (IRS); National Plan & Provider Enumeration System (NPPES); Health Facilities Information System (HFIS); American Board of Specialties; OMIG Sanction Interface, and other state agencies. Maintain audit trail and source information

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for all electronic verifications.

Question

Please clarify that the R-MMIS contractor only needs to perform electronic verification with the entities listed and isn’t required to provide a credentialing service?

The R-MMIS contractor will provide the interfaces with these entities to allow for verification of enrollment information; however, the Department will maintain the credentialing process.


FPH1-113

83 of 145

RFP Text

11. process and maintain information received from external sources (e.g., NYS Education Department, CLIA, CMS and NPPES) related to both enrolled and unenrolled providers based on Department business rules including but not limited to:

a. licensing and credentialing information;

b. National Provider Identifier; and

c. other information.

Question

Please clarify that the external sources listed are the sources for licensing and credentialing information and that the R-MMIS contractor isn’t required to provide a credentialing service?

The R-MMIS contractor will provide the interfaces with these entities to allow for verification of enrollment information; however, the Department will maintain the credentialing process.


Claims/ Encounter Adjudication

FPH1-223

Topic/Issue:

X12 837 Professional (Versions 4010 & 5010)

RFP Text:

1. Accept, process and respond to electronic claims

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Page 93 of 146

transactions received in HIPAA standard formats including:

a. X12 837 Professional (versions 4010 & 5010);

b. X12 837 Institutional (versions 4010 & 5010);

c. X12 837 Dental (versions 4010 & 5010); and

d. NCPDP Pharmacy (versions 5.1, D.0, and 1.1 - batch).

Capture the information contained in those transactions based on Department business rules.

Discussion:

Since only 5010 is mandated after Jan 1, 2012 why does DOH require the R-MMIS system to continue to support 4010 transactions?

Question(s):

Is the requirement for the R-MMIS system to support Version 4010 standards and Version 5010 standards concurrently?

As the 5010 is mandated after Jan 1, 2012 how long does DOH require the R-MMIS system to continue to support 4010 transactions?

The R-MMIS must support only the latest 5010 and NCPDP version of the transactions.


Service Authorizations System

Topic/Issue:

4010/5010 issues

RFP Text:

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Requirements

FPH1-223

Page 93 of 146

“Accept, process, and respond to HIPAA standard formats; both 4010 and 5010

Discussion:

N/A

Question(s):

Will the Department require the contractor to supply Version 4010 responses (835) for Version 4010 (837) transactions, or would 5010 (835) responses be acceptable? If 4010 responses continue to be required, for what period of time will the support be required?

The R-MMIS must support only the latest 5010 and NCPDP version of the transactions.


FPH1 – 130

85 of 145

RFP Text

4. Provide the ability to automatically generate orders for Department forms when the provider's inventory falls below Department specified levels. The inventory level must be maintained for each provider identified by tracking the number of paper Department supplied forms submitted and reducing the inventory levels based on Department business rules. This will include tracking the order from receipt through fulfillment. The order status must be available to requestor through the provider area of the web portal.

Question

Please provide a list of the form types that are included under this requirement, the approximate number of providers for which forms inventory management is performed, and the average annual number of shipments per provider.





Tab III.J, requirement

Can you confirm that the only multi-lingual requirement in the RFP is the production of EOBs in both English and Spanish?

It is anticipated that all member correspondence and communications will require both English and Spanish translations. However, this requirement may expand to other

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FPH1-326 languages identified by the Department over the term of the contract. The offeror should propose a solution that best meet the needs of the Department.


FPH1-503 115 of 145

RFP Text

Generate federally mandated reports (e.g., CMS-64.9R)

Question

Please clarify what is required by this requirement. It seems the requirement is asking for MARS related reports; however, section E (page I-7) indicates MARS reporting is a component of the MDW project – please see RFP wording below.

From Section E – Page I-7

Offerors should note that concurrent with the R-MMIS project, the Medicaid Data Warehouse (MDW) will be designed, developed and implemented under a separate contract. Close collaboration between the MDW contractor, R-MMIS contractor, Department staff and Department contractor staff will be critical to the success of both initiatives. As the primary source of the MDW data, the R-MMIS serves as the foundation for the wide range of analytical activities and compliance with Federal MMIS certification requirements being fulfilled by the MDW. The MDW will rely on data extracted from the R-MMIS to provide Program Management (e.g., Data Warehouse, Management and Administrative Reporting Subsystem (MARS) and Federal reporting); Program Integrity (e.g., Surveillance and Utilization Review Subsystem (SURS), Retrospective Drug Utilization Review (R-DUR)); and, Care Management (e.g., Early and Periodic Screening, Diagnosis and Treatment) functionality.

The requirement refers to federally mandated reports that are identified during design, development and implementation of the R-MMIS. The R-MMIS will produce all reports and/or files for which it is responsible that are required to meet Federal CMS-64 reporting requirements.


FPH1-505

RFP Text

2. Produce all reports and/or files required to meet

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115 of 145 Federal CMS-64 reporting requirements.

Question

Please clarify the scope of the contractor’s responsibility to meet this requirement versus the MDW contractor’s Federal reporting responsibilities.

The RFP is amended to read: “Produce all reports and/or files for which the R-MMIS is responsible that are required to meet Federal CMS-64 reporting requirements.”


Attachment J Tab R-MMIS Functional Reqs FPH1-503 and FPH1-505

These requirements note that the R-MMIS will be responsible for creating the CMS-64 reports and any associated files.

Please confirm that the actual CMS-64 reports will be generated and sent from the R-MMIS, and not the MDW.

The RFP is amended to read: “Produce all reports and/or files for which the R-MMIS is responsible that are required to meet Federal CMS-64 reporting requirements.”

425 ATT J Attachment J Commercial Insurance System Requirements

The eMedNY Third-Party Liability Subsystem TDD describes processing of Health Insurance Premium Payments (HIPP). The RFP did not contain detailed requirements for HIPP processing.

Is HIPP a required function of the replacement system? If it is please provide the necessary requirements.

How does the social services office need to access the R-MMIS for HIPP?

HIPP is a required function of the R-MMIS.

Yes, the offeror should propose a solution that best meets the needs of the Department.

LDSS offices will be connected using NYeNet. 426 ATT J Attachment J

FPH1-160

87 of 145

RFP Text

2. Provide the capability to convert x-rays and other radiological films to digital images of quality usable by the Department for medical review.

Question

Please quantify the annual or monthly number of x-rays and films needing to be digitized by type (e.g. dental, general radiography).

The Department estimates 15,000 total films are submitted each month and 10% of that total is currently submitted in a digital format. Please note this is a current estimate of volume and may not provide a good basis for estimating future activity.

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427 ATT J, Tab III.J

Attachment J FPH1-160

During the Operations Phase, please provide statistics on how many X-Ray or radiological images will be scanned/converted per month.



FPH1-563

RFP Text 16. Provide the capability to publish current formulary information, on a timetable determined by the Department, via the web portal in formats approved by the Department.

Question Please confirm that it is neither the contractor’s responsibility to establish the formulary nor to make final decisions regarding treatment issues.

This question is not relevant to the RFP text cited.

Formulary is defined as a list of all drugs reimbursable by the Medicaid Pharmacy program, including but not limited to PDP drugs.

Requirements related to administration of the formulary are located in Attachment J, Bidder Requirements Traceability Matrix: Tab III F. Operations.

Requirements related to creating and maintaining lists of drugs specific to pharmacy benefit management are located in Attachment J, Bidder Requirements Traceability Matrix: Tab III J. R-MMIS Functional Requirements.

The Department requires the contractor to provide clinical expertise consistent with original language throughout the RFP.


Attachment J Tab R-MMIS Functional Reqs FPH1-160

Requirement states: “Provide the capability to convert x-rays and other radiological films to digital images of quality usable by the Department for medical review.” • Is there an x-ray scanner in production today?

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• If so, when was it implemented? • What is the expected volume of x-rays to be received?

• What is the specific scan resolution necessary to meet this requirement?

• Does “convert” mean scan?

• What is meant by “other radiological films?”

• Is there an expectation of conversion of historical hard copy microfiche or other such media?

There is not an x-ray scanner in production today

The Department estimates 15,000 total films are submitted each month and 10% of that total is currently submitted in a digital format. Please note this is a current estimate of volume and may not provide a good basis for estimating future activity.

The scan resolution must be sufficient in quality to meet standards for professional clinical review.

Convert means converting hard copy films to an equivalent digital format for the purpose of professional clinical review.

Radiological films include x-ray, ultrasound, CT and MRI films.

It is not expected that historical hard copy microfiche or films related to medical review activities will be converted.


FPH1-225

92 of 145

RFP Text

3. Provide the capability to process and respond to all electronic claim transactions in real time using HIPAA standard formats based on industry standards and Department requirements.

Question

Please clarify what is meant by real time in this requirement.

Is this requiring the creation of the 997 transaction back to the submitter once the 837 transaction is received?

For transactions received in real time, the contractor must provide real time adjudication capability for all claim types, using HIPAA standard formats.

No.

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431 ATT J Tab III.J, requirement TSA-72a

Please provide what period of time must the minimum transfer capacity of 1GB be met.

Per second.

432 ATT J Attachment J TSA-77

RFP Text

Provide a dedicated POTS line at each facility for dial-up access into the network from Albany, New York;

Question

Please clarify if a dedicated POTS line is required at each contractor facility, each Department facility, and each Regional facility.

Please provide a list with addresses and telephone numbers of the State, Department, Regional, or other facilities that require the dedicated POTS line, thereby enabling effective costing.

The line is required at each location where the contractor has state equipment.

The current network design is not relevant to the R-MMIS. The offeror should provide a network design in its proposal based upon its proposed R-MMIS and that best meets the Department’s requirements.


Attachment J TSA-258

Please provide a list of existing eMedNY reports must be converted or migrated to the proposed document repository.

Please provide the total size of the archive of reports in gigabytes to be converted.

Please refer to the R-MMIS Procurement Library.

434 ATT J Tab III.J, requirement TSA-261

Which written languages are required to be produced by the letter generator? Will this be for every letter template, or what percentage will be?


435 ATT J Tab III.J, requirement TSA-286

Are any languages other than English required to be captured in the COTS contact management system?

No.

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Attachment J TSA-14

Please provide total printed pages per month for the most current 12 months. Provide a breakdown of volume by letters, statements, checks, reports, notifications, and other available categories.





FAC-2

Page 130 of 146

Topic/Issue:

Contractor Lease Agreements

RFP Text:

2. Provide the Department appropriate time to review and approve all lease agreements.

Discussion:

N/A

Question:

Given the contractor’s responsibility for all aspects of the facility, and that the facility may contain non-DOH work, or the facility may already be subject to an existing lease with the contractor, please explain the need for the Department to review the lease and, if such a review is necessary, what aspects of the lease does the Department wish to review?



FAC-22

129 of 145

RFP Text

10. Provide an archival facility to house archived data as described in this RFP

Question

Please describe how requirement FAC-22 differs from FAC-58 which requires “adequate secure storage for physical and


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electronic historical records.”


FAC-22

FAC-58

Page 130 & 132 of 146

Topic/Issue:

Archived data and storage of electronic and paper media

RFP Text:

10. Provide an archival facility to house archived data as described in this RFP

27. Provide adequate secure storage for physical and electronic historical records;

Discussion:

N/A

Question:

We understand the need to archive program data offsite at a secure location and that this data would be archived on physical electronic media. With regard to the second requirement for secure storage for physical and electronic historical records, is it acceptable to also store paper program documents (e.g., claim forms, PA forms, and archival checks) at a location apart from the primary facility?

Yes.


FAC-44

Page 131 of 146

Topic/Issue:

Signage in the front of the building

RFP Text:

13. Provide signage in the front of the building as specified by the Department.

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Discussion:

Please note that the contractor through its lease may have a limited ability to control signage on the exterior of the facility. In addition, municipal codes often impose further restrictions on the use of such signage.

Question

Please clarify the types of signage and signage content that might be specified by the Department.

Signage may be no larger than allowable under the location’s zoning regulations. The Department will specify content at the appropriate time.


FAC-50

130 of 145

RFP Text

Protect power and telecommunications cabling carrying information or supporting information services from interception or damage. The Contractor must document what existing power and/or cabling is covered by this standard and must communicate that to the Department for appropriate protective action;

Question

Please clarify if this requirement applies only to the cabling within a facility.

This is for any and all cabling within any of the contractor’s facilities.


FAC-50

Page 131 of 146

Topic/Issue:

Protect Power and Telecommunications Cabling Information

RFP Text:

19. Protect Power and telecommunications cabling information or supporting information services from interception or damage. The Contractor must document what existing power and/or cabling is covered by this standard and must communicate that

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to the Department for appropriate protective action;

Discussion:

N/A

Question:

Please clarify the meaning of the term “appropriate protective action” and whether the contractor will be responsible for Department directed actions that are not included in the contractors fixed priced bid?

The offeror should propose a solution that best meets the needs of the Department. The contractor must meet all requirements as set forth in the contract resulting from this procurement.


FAC-79

131 of 145

RFP Text

36. Provide a Model Office Environment (MOE) to accommodate a maximum of thirty (30) concurrent users, available to the Department, to facilitate necessary testing.

Question

Is the Department requesting a test environment for these users or an office environment to accommodate the 30 users that are dedicated to Model Office testing?

The concurrent users will access UAT or ITF. The requirement is for an office environment.


FAC-86

132 of 145

RFP Text

(3) a. 70 staff will occupy the Department’s office suite.

Question

There is a discrepancy between the number of FTEs identified and the office requirements for the Department. For example, FAC-123 requires 94 cubicles. Please clarify that the cubicle/office requirements identified in FAC-123 AND in FAC-133 are correct.

There will be approximately 70 FTE at the primary facility that will be intermingled with contractor’s staff. Twenty-four (24) additional cubicles are necessary for additional Department contractors and Department program staff who may be at 2 locations (e. g., pharmacy staff, staff from eligibility systems, etc.).

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FAC-107

132 of 145

RFP Text

7. Provide and maintain enough personal computers for all staff on premise with a minimum of two (2) LAN connections. The computers . . .

Question

Does “all staff on premise” refer to the 114 State, Federal, and State consultant staff identified in FAC-85?

The 114 staff and the 24 additional cubicles for a total of 138.

446 ATT J, Tab III.K

Attachment J Tab III.K Facility FAC-106

Can the State provide an estimate of anticipated usage of the toll-free lines for Department staff?

That information is not available at this time.


Attachment J FAC-70 Facility

The RFP states: “b. Provides back-up generators in the event of a power outage; and”

If Operational facility is in a separate building or physically secured from the computer facility sites, are back-up generators required for the Operations facility used by the contractor? If so, are the Operational facility back-up generators required to meet the same Uptime Institute Tier Level as the computer facility?

Yes.

Yes.



The RFP states: “c. Includes multiple feeds to avoid a single point of failure in the power supply;” If Operational facility is in a separate from the computer facility sites, are multiple power feeds required for the Operations facility used by the contractor? Also, in either case, is each power feed required to originate from a completely different source (diverse power stations and/or diverse utility companies)?

Yes.

Yes.



The RFP states: “Protect equipment from physical risks, including but not limited to power failures and other electrical

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anomalies. A suitable electrical supply shall be provided that: a. Includes a dependable power supply with an uninterruptible power supply (UPS) and surge protection devices for equipment supporting critical business operation to support orderly shut down or continuous running until operations may be transitioned to the hot site. Equipment must be regularly checked to ensure it has adequate capacity and tested in accordance with the manufacturer's recommendations;” Because this requirement does not indicate which facility it is required for, please define if this requirement pertains to the Operational facilities or Computer facilities. If FAC-69 is required for more than the computer facilities, please define how many minutes of up-time would be required for an Operational facility? Also, please define the “critical business operation” in terms of system or application function.

This requirement pertains to the primary computer facility and DR facility as well as the Operational facility.


All business functions described in the RFP. 450 ATT J Attachment J

FAC-78, FAC-79

Page 132 of 146

Topic/Issue:

Multi-purpose meeting room and Model Office Environment (MOE)

RFP Text:

35. Provide a multi-purpose meeting room(s) at the Contractor’s facilities, available to the Department, with all necessary equipment to support a maximum of 150 individual participants.

36. Provide a Model Office Environment (MOE) to accommodate a maximum of thirty (30) concurrent users, available to the Department, to facilitate necessary testing.

Discussion:

N/A

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Question:

Please confirm whether these meeting rooms and model office environments are to be located within the Department’s requested 27,700 square feet.

Yes, they will be included in the Department’s requested 27,700 square feet.


FAC-80 through 173

Page 133-136 of 146

Topic/Issue:

R-MMIS Facility Requirements Description - Facility

RFP Text:

The Contractor must:

1. Provide at the primary project site at least twenty-seven thousand seven hundred (27,700) total usable square feet of secured office space. This space will be used by the Department's staff, Department's contract staff, staff from the Office of the State Comptroller (OSC) and staff from the Federal Office of the Inspector General (OIG).

Discussion:

We have totaled all of the office, work station, conference room, storage, and general use facilities included in these RFP Sections and approximated the square footage needed to accommodate all of these spaces. Even including a reasonable factor for aisles, utility closets, copy rooms and hallways we are unable to validate the Department’s request for 27,700 square feet. Our total is approximately 1/3 less.

Question:

Please confirm that the Department does in fact require 27,700 for State and Federal staff.

Yes, the original RFP language meets the needs of the Department.

452 ATT J Attachment J Topic/Issue:

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FAC-108

Page 134 of 146

Parking Spaces

RFP Text:

8. Provide a parking area contiguous to the building with a minimum of one hundred twenty-nine (129) reserved parking spaces for the Department. This number does not [sic] include fifteen (15) visitor parking spaces but does not include any required handicap spaces.

Discussion:

N/A

Question:

Please confirm that the 129 reserved parking spaces include all parking that is to be assigned to DOH.

The contractor must provide 129 reserved parking spaces for the Department inclusive of fifteen (15) visitor parking spaces. The contractor must also provide additional handicap spaces as required by law.


FAC-113 to 121

Page 134 of 146

Topic/Issue:

Training Room

RFP Text:

The contractor must provide a training room in the primary facility with the following capacity:

Handle up to 30 students at one time

Provide each student with desk space and their own PC

Provide access to the Department LAN and the training environment

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Provide enough LAN printers to accommodate the training

Provide a ceiling projector, amplifier, DVD player and appropriate loud speakers

Provide ample white board space

Provide two flip charts

Furnish and maintain appropriate hardware, software, and telecommunications to support the development, maintenance and presentation of training programs(s);

Discussion:

N/A

Question:

Is the training room referenced in these sections anticipated to be dedicated to State use and to be located within the 27,700 square feet assigned to the State?

Yes.


FAC-123

FAC-86

Page 133-134 of 146

Topic/Issue:

Department seating

RFP Text:

Within the Department’s twenty-seven thousand (27,700) square feet of usable office space the contractor will provide:

Ninety-four (94) flexible, integrated cubicles approximately sixty-four (64) square feet each; Each cubical shall have:

70 staff will occupy the Department’s office suite

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Discussion:

N/A

Question:

Within its assigned space, DOH appears to be requesting seating accommodations for 104 staff, however FAC-86 indicates 70 staff will occupy the Department’s office suite. Please clarify this requirement.

As specified in the RFP, 10 offices and ninety-four (94) flexible, integrated cubicles are required within the Department’s office suite.


Department Specific Requirements

FAC-136

Page 86 of 146

Topic/Issue:

File Server

RFP Text:

“A local file server with secure storage capability of at least five terabytes.”

Discussion:

N/A

Question(s):

What is the function of this server? Will the contractor be responsible for providing software for this platform, and if so, what software will be required?

This server will be connected to the LAN and provide access for the Department’s staff to share files and documents, project plans and administrative documents. This server will be firewalled so that only Department staff will have access.

The server requires backup, business continuity, and DR services.

The server shall have the following minimum configuration:

Rack Mountable Server with Rack, Quad Core CPU’s, 16 –

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32 GB RDIMM Memory, Internal DVD+/-RW, SATA Internal, Raid Controllers configured for System and Storage Hard Drives, 5 TB Internal Storage (Drive type to be determined), External Drive Shelf for Near Line Data Backup and Storage, 5 – 8 TB External Storage (Drive type to be determined), Dual Port 10 Gbe NIC, Embedded Server Management, Slide Ready Rails with Cable Management, Uninterruptable Power Supply; 2700 Watt 3U, 120 Volt, with L5-30P, 2m Cord, Symantec Backup Exec 2010 Server Suite w/ Bare Metal Recovery.

456 ATT J, Tab III.N

Attachment J Tab III.N Training TN-41

Please provide copies of current Training Evaluation Forms and the Training Summary reports for the last 12 months.

These materials are not relevant to the R-MMIS.


II.J Functional Requirements Tab

Topic/Issue:

Lack of Req ID

RFP Text:

8. Track each EFT maintenance transaction through all the steps in the maintenance process as defined by the Department using the Workflow Management System. (after FPH1-650)

Discussion:


Question:

Request a REQ ID be assigned.

FPH1-650a


II.J Functional Requirements

Topic/Issue:

Lack of Req ID

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Tab

RFP Text:

4. Provide the capability to process electronic prior approvals received in HIPAA X12 standard formats. (after FPH1-147)

Discussion:

This requirement lacks an identification for mapping. It also has a duplicate sequence number (i.e., 4) as the following requirement.

Question:

Request a REQ ID be assigned and the duplicate number be corrected.

FPH1-147a


III.N Training Tab

General

Topic/Issue:

Lack of Req ID

RFP Text:

3. Base the Training Plan upon the Department's R-MMIS project goals, the Contractor's proposed solution, and the Contractor's own experience with comparable MMIS Projects. The Plan must include methods to develop and deliver the necessary training to ensure effective development and use of the R-MMIS. The Training Plan must address the expected training outcomes detailed in this RFP.

Discussion:


Question:

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Request a REQ ID be assigned. TN-2a

460 ATT K Attachment K

All pages

Please clarify how the bidder should interpret the yes/no responses shown in the 15 Certification Checklists contained in Attachment K.

Do these responses represent the State’s assessment of the current eMedNY system or do they reflect the desired yes/no condition of the future R-MMIS in terms of detailed Medicaid Enterprise Certification Toolkit (MECT) system review criteria? There a certification [sic]

The yes/no responses in the Certification Checklist reflect the minimum yes/no responses for the R-MMIS.

461 ATT K Attachment K

All pages

There are 5 missing checklists in Attachment K. Will the Department please confirm that these five checklists are the contractual responsibility of the MDW contractor?

The following checklists are not the responsibility of the R-MMIS contractor:

Immunization Registry Interfaced Checklist

Managed Care Enrollment Checklist

Managed Care Organization Interfaces Checklist

Managed Care PCCM and Gatekeeper Checklist

Managed Care PIHP and PAHP Checklist

462 ATT K Attachment K Certification Checklists Section ME04

System Review Criterion ME1.15 states, “Supports ANSI X12N 834 transaction as required by the Health Insurance Portability and Accountability Act (HIPAA).” We can find no other references within the RFP to 834 transactions. Is the R-MMIS expected to create the HIPAA 834 transactions (enrollment rosters) that are outbound to the Managed Care plans and providers or is another system responsible for this?

Please refer to the Client TDD in the R-MMIS Procurement Library.

463 ATT L Attachment L, Deliverables List Page 1 of 10

RFP Text Project Planning Phase:

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Project Management Methodology

Question Attachment L includes entries for deliverables that appear to correspond directly to RFP Section III Requirements and Attachment P requirements. Please confirm that Bidders are not required to provide separate deliverables for these entries as long as they are covered in a Bidder’s response to the corresponding requirements in RFP Section III and Attachment P.

All deliverables listed in Attachment L with a “Yes” indicated in the “In Proposal?” column must be included in offeror proposals. These deliverables may be submitted in a offeror’s response to the corresponding requirements in RFP Section III and Attachment P as long as these deliverables can be easily identified by the Department.

464 ATT L Attachment L, Deliverables List Page 1 of 10

RFP Text Project Planning Phase:

Question Attachment L asks for Quality Assurance Procedures to be included with the proposal. Because Bidders are also required to submit a Quality Management Plan with their proposals, may the Quality Assurance Procedures be included in the Quality Management Plan, or must the Quality Assurance Procedures be submitted as a separate Deliverable?

These both may be submitted together as long as each can be easily identified by the Department.

465 ATT L Attachment L

Page 1 of 10

Topic/Issue:

Quality Management Plan

RFP Text:

RFP Section # Phase/Task Deliverable

In Proposal? Due Date

III.B Quality Management Plan

Yes Proposal Due Date

Discussion:

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Attachment L calls for the Quality Management Plan to be delivered with the proposal. But, Section III.B.2.2 calls for the plan to be done during the Planning Phase. Submission of a formal plan as of the proposal submission date does not provide for the precise tailoring of the plan that should take place during the Planning Phase.

Question:

Does the Department require a formal plan be delivered with bidders proposals, or is a detailed description of our intended approach and an outline sufficient for proposal submissions?

The proposal must include everything identified in Section III.B.2.2.1 Proposal Requirements. The plan will be developed during the Planning Phase.

466 ATT L Attachment L

Page 1 of 10

Topic/Issue:

Quality Assurance Procedures

RFP Text:

RFP Section #

Phase/Task Deliverable In Proposal? Due Date

III.B Quality Assurance Procedures

Yes Proposal Due Date

Discussion:

Attachment L calls for the Quality Assurance Procedures to be delivered with the proposal. But, Section III.B.2.2.1 only calls for a description of the procedures to be included in the proposal. Submission of actual procedures as of the proposal submission date does not provide for the precise tailoring of procedures that should take place during the Planning Phase.

Question:

Does the Department require actual procedures be delivered

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with bidders’ proposals, or is a detailed description of our intended approach sufficient for proposal submissions.

The proposal must include everything identified in Section III.B.2.2.1 Proposal Requirements. The procedures will be developed during the Planning Phase.

467 ATT L Attachment L (Deliverables List/Implementation Phase/Software Development Lifecycle) 2 of 10

RFP Text Sample deliverables…including but not limited to… General Design Document,

Question The RFP uses several terms to describe a general design deliverable, specifically:

Logical Design Document (Attachment L, page 3 and Attachment J, IP-101)

Business Design Document (Attachment P, SDLC-4; Attachment. J, IP-21; and RFP page III-20, item d )

General Design Document (Attachment L, page 2

Please either confirm these are one and the same or clarify the differences among them.

These three documents are one and the same.

468 ATT L Attachment L (Deliverables List/Implementation Phase/Software Development Lifecycle) 2 of 10

RFP Text Sample deliverables…including but not limited to… Detailed l Design Document,

Question The RFP uses two terms to describe a detailed design deliverable as follows:

Physical Design Document (Attachment L, page 4 and Attachment J, IP-113)

Detailed Design Document (Attachment P, SDLC-6; Attachment

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J, IP-22; Attachment L., page 2; and RFP page III-20, item d)

Please either confirm these are one and the same or clarify the differences between them.

These documents are one and the same.

469 ATT M Attachment M

Section III

Attachment J

Topic/Issue:

Pricing for Implementation Functional Phase III

RFP Text:

Attachment M / Section III / Attachment J

Discussion:

There does not appear to be a pricing sheet specific to Implementation Functional Phase III. Additionally, there do not appear to be specific deliverable requirements for this phase.

Question:

Please specify how the offerors are to provide pricing specific to Implementation Functional Phase III.

Please identify specific items to be delivered during this phase and the acceptance criteria.

All Phase III activities will be undertaken using the System Change Request Process. Pricing for this is included in the pricing schedules.

There are no specific items identified at this time.

470 ATT M Attachment M Pricing Schedules

Page 2

RFP Text In Pricing Schedules D.1, offerors must detail the other expenses from “Personnel-related pricing”, “Facility pricing” and “Other operations pricing” detailed on Pricing Schedule D. Question There are certain implementation costs associated with a new operation start-up that the incumbent contractor will not incur. As other states do to create a competitive procurement, will the Department consider offsetting non-incumbent implementation costs such as Facility, Infrastructure, and Network, etc.?

Since this is a replacement system, the Department believes that the incumbent contractor will have to meet the same implementation requirements as non-incumbent contractors related to Facility, Infrastructure and Network.

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Pricing Schedules

Pricing Schedule D

Topic/Issue:

Corporate allocations and markups

RFP Text:

"Offerors must include the percentages applied for corporate allocation (cell B43) and markup (cell B46)."

Discussion:

These two cells are the only places on the pricing worksheets that address Corporate Allocation and Markup percentages.

Question(s):

Is the offeror to assume that the percentages included in these two cells are applicable to all contract years?

This topic also relates to the calculation of Reimbursement for Supplemental Staff. It is suggested that the pricing schedules be modified to allow adjustment of these percentages for all years of the contract individually.

Yes.



Pricing Schedules

Pricing Schedule D

Topic/Issue:

5 year allocation

RFP Text:

"The contractor will be paid an amount equal to twenty percent (20%) of the total proposed price for each year of operations.”

and

"Equal monthly payments will be made to the contractor over

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the scheduled five years of operations."

and

"Offerors must include the percentages applied for corporate allocation (cell B43) and markup (cell B46)."

Discussion:

Committing to fixed monthly payments for a five year period may result in higher than necessary costs to NY in the earlier years due to the averaging of escalation and timing of expenses.

Question(s):

Would the Department consider expanding Schedule D to allow for pricing for each of the 5 years individually, which would include the rows for allocations and markups?


473 ATT M Attachment_M2-1 Volume Adjustment; Tab E

When reviewing claim counts, we want to ensure that we understand what is included in the claim count. • Please define what the unit of a claim that is being

counted. In particular, is a “claim” considered the header record plus all detail lines? Or, is each detail line counted as a claim in and of itself?

Definition of a Transaction

The reimbursement of the contractor for the fixed rate per transaction will be based on fee-for-service claims transactions and managed care encounter transactions submitted for processing. For the purpose of transaction volume accounting and reconciliation of changes in contractor reimbursement, the following definitions, subject to the qualifiers also noted, shall apply to administrative processing counts tracked and reported by the contractor. The contractor shall certify and demonstrate that the definition and accounting of transactions processed for the purposes of possible adjustments is in conformance with the following definitions.

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1. Claims Transactions

Fee-for-service claims transactions are defined as follows:

• Inpatient hospital and long-term care claims - A claim is a paper document or an EMC record requesting payment for services rendered during a statement period for which there are one (1) or more revenue or procedure codes.

• Institutional Medicare crossover claims (inpatient and nursing facility) - A claim is a paper document or an EMC record requesting payment for services rendered during a statement period.

• Drug claims - A claim is each detail line item of a paper document or an EMC or a POS record requesting payment of a specific service/drug code rendered to a recipient by the billing provider.

• All other claim types - A claim is a line item on a paper document or an EMC record requesting payment for services rendered during a statement period for which there is one (1) HCPCS, revenue code, or other service code.

If the Department determines that claims are being inappropriately adjudicated, such inappropriate adjudications shall be eliminated as countable transactions.

Adjustments to fee-for-service claims submitted by providers are countable as a transaction, except as specified in number 3, below.

All claims that require reprocessing, including mass adjustments, are not countable as transactions.

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Electronic media claims (EMC) are defined for reimbursement purposes to be identical to paper claims regardless of EMC record definition or media.

2. Encounter Data Transactions

Managed care encounter data relating to medical services provided shall be tracked as if it were a claim transaction for accounting purposes and counted when submitted to the R-MMIS for reporting purposes by the managed care entity. Accounting of encounter data shall be in accordance with the existing accounting definitions above for fee-for-service claims. Encounters submitted on electronic media are defined for reimbursement purposes to be identical to those submitted on paper.

3. General Transaction Requirements

No transaction shall be counted that does not meet the specific criteria stated above. Specifically excluded are claim header/trailer records, financial transactions, recycled pended claims, adjustments, cost settlements, file or system inquiries, prior authorization requests, on-line updates, file updates, claim correction transactions, Medicare Buy-In premiums, TPL premiums, and capitation payments for health care plans, gatekeeper fees, or separate capitation rates paid to primary care providers or managed care organizations.

Also excluded from the transaction counts shall be all mass adjustments and reprocessing due to retroactive rate changes or errors caused by incorrect contractor staff actions or inaccurate

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• Are denied claims included in this count?

system data or processing. Transaction counts shall not include claims returned to providers as a result of manual prescreening of receipts or after entry into the system when edit codes considered by the Department as prescreening criteria are posted and other claims are deleted by the system and later resubmitted.

The contractor shall provide weekly contract administration summary reports which identify, by provider type and by transaction type, the number of claim transactions and encounter data transactions received; the transactions processed; and the inventory on hand. The inventory reporting shall include all transactions in process, including pended transactions, by location. All counts and totals shall be unduplicated and shall reconcile to other claims processing and payment reports.

Regardless of whether claims/encounters are defined as a document or a line-item under the criteria stated above, counts of inventory processing detail shall be maintained and reported by document, claim line, and electronic record.

The adjudication results do not impact claim count.

474 ATT M Attachment_M2-1 Volume Adjustment; Tab E

If header claim is the unit for the volume count, please provide the average number of detailed claim lines per claim header, by claim type.

This information is not relevant to the volume count process.

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475 ATT M Pricing Schedule F – Supplemental Staff Price Attachment M, Page 2

“In Pricing Schedule F, offerors should submit the fixed hourly rate for each labor category identified and calculate the total annual price for each labor category and the total for each contract year. Using the attached “Attachment M - Pricing Schedules MMIS RFP.xls” spreadsheet, offerors need only complete the shaded cell indicating the hourly rate for each labor category. The hourly rate must be a fully loaded rate and include all personnel, overhead, indirect, travel, profit, equipment usage, and other miscellaneous costs. The contractor will be reimbursed at the hourly rates proposed for time each individual is used on identified and approved Department projects. Time spent by these individuals for such activities as training or administrative time is to be included in the Operations annual administrative fee and will not be paid separately.” Since it is unknown how many of the 200,000 hours will be used in any given year, would the State consider including indirect costs—particularly space, space related, and computer costs—in the Operations fee?

No, the hourly rate should be a fully loaded rate consistent with instructions in Attachment M.


Pricing Schedule G – Turnover

Page 3

RFP Text

In Pricing Schedules G, offerors should submit the fixed price for all activities required to support the turnover tasks required by this RFP and as detailed in the Turnover Plan approved by the Department.

Question

Should the “Price Offer for All Turnover Effort” include the cost of annual updates to the Turnover Plan during the potential contract option years?

No. Updates of the Turnover Plan are required annually (Section III.G.1: “Thereafter, the Turnover Plan must be updated annually prior to the start of the next year of operations.”) Therefore, it would be logical for annual updates to be included in the annual administrative fee. However, offerors are free to put the price in either the fixed administrative fee or turnover pricing.

477 ATT N Page 1 RFP Text

When the Bidder submits a proposal to this RFP, the Bidder should submit an executed Commitment Letter, in the form set

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forth below, from a financial institution which is licensed to transact business in the State of New York, on the financial institution’s letterhead. The executed commitment letter should be included as part of the Bidder’s Proposal.

Question

Where should the Commitment Letter be included within the proposal? Should it be placed in the Technical Proposal or Price Proposal?

An executed Letter of Credit Commitment Letter should be placed in the Technical Proposal: Tab 2, following the Transmittal Letter.

478 ATT N Attachment N Letter of Credit Commitment Letter

Instructions in Attachment N, the Letter of Credit Commitment Letter, tell bidders to include the letter “as part of the Bidder’s Proposal.” Where would the State like to see this Letter of Credit:

• Technical Proposal: Tab 2, following the Transmittal Letter?

• Price Proposal: Tab 5, with other Company Financials?

If neither of these locations, please specify the location for Attachment N, the Letter of Credit.

An executed Letter of Credit Commitment Letter should be placed in the Technical Proposal: Tab 2, following the Transmittal Letter.

479 ATT O Attachment O

Staffing Requirements

Page 1 of 23

Attachment J

Page 141 of 146

OAS-20

Topic/Issue:

Qualifications and Experience Charts

RFP Text:

Att. O For Key Staff: The contractor must name individuals and provide resumes in its proposal that will fill the twenty-one (21) key staff positions. The contractor must also complete twenty-one (21) Qualifications and Experience Charts provided at the end of this attachment.

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Att. J OAS-20 5. Will submit a Staff Skills Matrix for each person filling a Key Staff position. The Matrix which is included in Attachment M summarizes relevant experience of the proposed staff

Discussion:

N/A

Question:

Attachment O requires “Qualifications and Experience Charts” for Key Staff; Attachment J requires a “Staff Skills Matrix”. For clarification purposes, are these the same documents?

In addition, Attachment J references a “Staff Skills Matrix” which is included in Attachment M. Would the department please provide the “Staff Skills Matrix” if it is different from the Attachment O requirement for “Qualifications and Experience Charts”?


480 ATT O Attachment O Staffing Requirements

8 of 23

RFP Text

Various text from Attachment O

Question

Within the 21 required named positions, there is an Enterprise Architect, a Technical Architect, a Data Architect, and a Database Administrator. For these four positions will the Department consider allowing for significant large-scale IT project experience with the proposed COTS products instead of MMIS specific experience?


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III.M.2

Classifications of Contractor Staff

Pages O.1-23

And III-155 &156

TOPIC/ISSUE:

Timing of assignment of Key Personnel and Timing of assignment of Core Personnel

RFP TEXT:

All proposed key staff must be available on the contract start date

DISCUSSION:

The RFP requires 21 key and 49 core staff be assigned to the R-MMIS project. In assessing the required skills for these individuals, while considering the approximate timing of the activities in the project phases, both the development phases and the eventual operations phase, it appears that the participation of certain staff would not be required at the time of project initiation, but rather would be required at later points in time, such as at the time operations activities planning is initiated. For example, the certain positions that would be required during the Operations Phase would likely need to be assigned to the project several months before actual operations are to begin, in order to oversee the establishment of operations processes, installation of equipment, outfitting of work areas, hiring and training of staff, etc. Even if these activities were to be initiated as early as one year prior to operations startup, that would still be as much as two years after the project start date. These positions, if assigned as of the first date of the project, would be on the project for as much as two years before their direct involvement would be necessary for operations planning and for 30 months prior to the beginning of the parallel test period. Similarly, for certain core staff, it appears that the assignment of certain positions to the core group, in particular certain development positions, would not be needed until close to the initiation of operations and the corresponding transfer of systems development activities from the implementation team to

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the Systems Change Staff.

QUESTION(S):

It is requested that the Department allow the offerors to propose phased staffing for certain key and core positions along with justifications for the rationale for the timing of assignment to the project.

No, the Department requires staff to be present from the first day of the contract.


Pages 5, 6, 8, 9, 10, 14, 15, 18, 20

TOPIC/ISSUE:

Educational Requirements for Key and Core Staff

RFP TEXT:

“Bachelor’s degree in Business Management or related field is required; MBA or related higher level degree preferred.”

“Bachelor’s degree in Business Management or related field is required.

“Bachelor’s degree in Information Technology or related field is required: MBA or related higher level degree preferred.”

“Bachelor’s degree in Information Technology or related field is required.“

DISCUSSION:

The RFP contains detailed requirements in regard to the educational and work experience requirements of the key, core, and supplemental staff. In order to ensure that the proposed staff have experience applicable to the Medicaid program it is requested that the Department consider a reduced emphasis on required educational accomplishments (e.g., bachelors degree required, master's degree preferred, generic certifications, etc.), and allow actual experience in the administration of Medicaid

The Department is providing additional information to clarify the educational and/or experience qualifications as follows:

A Bachelor’s degree with any major can be substituted for a Bachelor’s degree in Business Management or Information Technology. Experience can be substituted for a Bachelor’s degree as specified below. When substituting experience for education, the qualifying experience must be clearly noted on the Qualifications and Experience Charts. The substitution of experience for education does not modify the experience requirements specified in the R-MMIS Key Staffing Requirements.

Pg 5 – Director of Operations: If the proposed key staff person does not have a Bachelor’s degree, they must have at least nine (9) years experience in managing the claims processing component of a large-scale integrated healthcare claims processing system, preferably with the proposed MMIS solution; and at least seven (7) years significant business operational experience in Medicaid or another healthcare production environment.

Pg 5 - Director Customer Service: If the proposed key staff person does not have a Bachelor’s degree, they must have at least nine (9) years experience in managing the Provider Services component of a large-scale integrated healthcare claims processing system, preferably with the proposed MMIS solution; and at least six (6) years experience

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program activities and development of Medicaid applications.

QUESTION(S):

It is requested that equivalent years of direct experience in these areas be allowed to supplant educational degrees and certifications, on a year-for-year basis (i.e., one year of experience would be equal to one year of formal education).

managing a call center.

Pg 6 - Director Systems Design and Development: If the proposed key staff person does not have a Bachelor’s degree, they must have at least eleven (11) years experience in MMIS design, development, implementation, operations, maintenance, and modifications including experience with implementing major modifications to an MMIS or with major operations-related components of an MMIS or large-scale integrated healthcare claims processing system; and experience with the complete architecture and interfaces related to the proposed R-MMIS; at least nine (9) years experience simultaneously managing large scale concurrent projects and effectively responding to unanticipated Department business priorities; and at least nine (9) years experience managing a staff of over 50 in a complex IT environment.

Pg 8 – Enterprise Architect: If the proposed key staff person does not have a Bachelor’s degree, they must have at least twelve (12) years of experience in the planning and design of the technical aspects of an MMIS preferably in the proposed hardware and software environment and at least nine (9) years experience in directing performance measurements and performance tuning in MMIS or large-scale integrated healthcare claims processing system.

Pg 9 – Technical Architect: If the proposed key staff person does not have a Bachelor’s degree, they must have at least nine (9) years experience in MMIS design, development and implementations and at least nine (9) years experience in managing a staff of fifty (50) or more in a complex IT environment.

Pg 10 – Data Architect: If the proposed key staff person does not have a Bachelor’s degree, they must have at least nine (9) years experience in database design, development,

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implementation, operations, maintenance, and modifications; and at least seven (7) years experience with logical and physical database designs in an MMIS or large-scale integrated healthcare claims processing system.

Pg 10 – Database Administrator: If the proposed key staff person does not have a Bachelor’s degree, they must have at least nine (9) years experience as a Data Administrator in an MMIS or large-scale integrated healthcare claims processing system in the proposed database software.

Pg 14 – Development Manager: If the proposed core staff person does not have a Bachelor’s degree, they must have at least twelve (12) years experience in managing and overseeing large scaled projects comprised of sub-projects and distinct deliverables; and at least nine (9) years experience coordinating and delegating the assignments and tasks for a project staff numbering over 20.

Pg 15 – Senior Developer: If the proposed core staff person does not have a Bachelor’s degree, they must have at least ten (10) years experience with writing application software preferably in the software language being proposed; at least nine (9) years experience in data access, data structures, data manipulation and database programming in the proposed RDMS; and at least nine (9) years experience in testing and implementation, technical and user documentation, and software conversions.

Pg 15 – Developer: If the proposed core staff person does not have a Bachelor’s degree, they must have at least six (6) years experience with writing application software, preferably in the software language being proposed; at least six (6) years experience in data access, data structures, data manipulation and database programming in the proposed RDMS; and at least six (6) years experience in testing and implementation, technical and user documentation, and

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software conversions.

Pg 18 – Development Manager: If the proposed supplemental staff person does not have a Bachelor’s degree, they must have a minimum twelve (12) years experience in managing and overseeing large scaled projects comprised of sub-projects and distinct deliverables; and a minimum ten (10) years experience coordinating and delegating the assignments for the a staff numbering over 20.

Pg 18 – Senior Business Analyst: If the proposed supplemental staff person does not have a Bachelor’s degree, they must have a minimum of ten (10) years experience with the analysis and redesign of business processes; and a minimum of eight (8) years leading a group of staff numbering over 5 in the development of program specifications and the implementation of software solutions.

Pg 18 – Business Analyst: If the proposed supplemental staff person does not have a Bachelor’s degree, they must have a minimum of seven (7) years experience with analysis and redesign of business processes.

Pg 19 – Senior Developer: If the proposed supplemental staff person does not have a Bachelor’s degree, they must have a minimum of ten (10) years experience with writing application software in the proposed hardware and software environment; minimum of nine (9) years of experience in data analysis, data access, data structures, data manipulation, databases, programming, testing, software conversions; and a minimum of eight (8) years leading a group of staff numbering over 5 in the design of program specifications and the implementation of software solutions.

Pg 19 –Developer: If the proposed supplemental staff person does not have a Bachelor’s degree, they must have a

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minimum of six (6) years experience with writing application software, data analysis, data access, data structures, data manipulation, databases, design, programming, testing and implementation, technical and user documentation, software conversions.

Pg 20 – Database Specialist: If the proposed supplemental staff person does not have a Bachelor’s degree, they must have a minimum eight (8) years experience as a database administrator in a large IT environment preferably in a an MMIS or large-scale integrated healthcare claims processing system.

Pg 20 – Network Specialist: If the proposed supplemental staff person does not have a Bachelor’s degree, they must have a minimum eight (8) years experience as a network specialist in a large IT environment.

Pg 21 – Trainer: If the proposed supplemental staff person does not have a Bachelor’s degree, they must have seven (7) years relevant training experience, or equivalent and seven (7) years experience in delivering training.

Pg 21 - Technical Writer: If the proposed supplemental staff person does not have a Bachelor’s degree, at least seven (7) years relevant experience and at least seven (7) years experience in developing stakeholder material.

483 ATT O Attachment O Pages 6, 7, 8, 10, 18

TOPIC/ISSUE:

Staff experience in the use of COTS products proposed.

RFP TEXT:

“Demonstrated comprehensive experience using the proposed software development lifecycle methodologies and COTS products”

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“Must have three (3) years experience in the proposed SDLC suite of COTS products”

“At least five (5) years of experience in the proposed COTS product to be used to automate the testing process”

“At least five (5) years experience in directing the design of process workflows and automated components, preferably in the proposed COTS product”

“At least three(3) years experience with the proposed data modeling COTS product”

“Minimum of five (5) years of experience in workflow analysis with the proposed COTS product”

“Minimum of two (2) years experience in workflow analysis with the proposed COTS product”

DISCUSSION:

The categories of COTS products required by the Department in many cases have not existed until recently in acceptable standalone forms, forms that can be properly integrated with other standalone products, or as vender integrated suites.

CSC recommends the Department achieve its Section III requirements for easily understood R-MMIS documentation and ePMO status by modifying the introduction to the Attachment O Key and Core Personnel requirement sections to read:

“The following R-MMIS Key and Core Staffing Requirements tables are modified to accept the noted years of experience with the SDLC and COTS products offered, and also to accept the same number of years of experience with any automate design, development, implementation and ePMO related tools applied successfully to MMIS projects or projects of similar size, scope

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and complexity.

Additionally, in recognition of continual advances in compliance with industry standards and productivity features that COTS vendors introduce into their tools, Offerors shall describe how, before any Key or Core Personnel begin work on this contract, they will be trained to an appropriate level of proficiency with the “then current” versions of the COTS tools in this proposal”.

QUESTION(S):

Will the Department modify Section O pages 1 of 23 and 14 of 23 to insert the text recommend above or similar text acceptable to the Department, as a global change for all Key and Core Personnel?


484 ATT Attachment O

18 of 23

RFP Text

Supplemental Staff – Turnover Coordinator

Question

Pricing Schedule F “Supplemental Staff Price” does not separately list a Turnover Coordinator; however, Attachment O lists a Turnover Coordinator as supplemental staff.

Will Pricing Schedule F be modified to include the Turnover Coordinator, or are bidders to estimate Turnover Coordinator effort as a part of the turnover phase and include it in Pricing Schedule G “Turnover”?

Offerors are to estimate the Turnover Coordinator effort as a part of the turnover phase and include it in Pricing Schedule G “Turnover.”

485 ATT O Attachment O Page 20

TOPIC/ISSUE:

Staff Qualifications/Experience of Supplemental Staff position, “Database Specialist”

RFP TEXT:

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Database Specialist

“Minimum four (4) years experience as a database administrator in a large IT environment preferably in a an MMIS or large-scale integrated healthcare claims processing system”

“Minimum of eight (8) years experience in the contractor’s proposed database that is beyond the requirements of a developer or senior developer”

“Minimum of three (3) years experience in the installation and operation of a database in an MMIS or large-scale integrated healthcare claims processing system”

“Minimum two (2) years experience implementing database security and encryption”

“Bachelor’s degree in Information Technology or related field is required”

Senior Developer

“Minimum of six (6) years experience with writing application software in the proposed hardware and software environment”

“ Minimum of five (5) years of experience in data analysis, data access, data structures, data manipulation, databases, programming, testing, software conversions”

“Minimum of four (4) years leading a group of staff numbering over 5 in the design of program specifications and the implementation of software solutions”

“ Bachelor’s degree in Information Technology or related field is required; MBA or related higher level degree is preferred”

DISCUSSION:

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We have identified an RFP qualification for the Database Specialist position that seem to be inconsistent with certain practices and career progression paths that have become very commonplace in the IT industry. This inconsistency is as follows:

The “Database Specialist” Supplemental Staff position requires a “Minimum of eight (8) years experience in the contractor’s proposed database that is beyond the requirements of a developer or senior developer”. This requirement suggests that a Database Specialist must have worked in an applications development function for at least 6 years (which is the requirement for a Senior Developer). Common industry practice for several years has been for DBA’s to begin their careers working in DBA positions, rather than working for a period of time as applications developers, and then transitioning to a DBA specialization. As a result, many highly experienced Database Specialists do not have The “Senior Developer” qualifications set forth in the RFP, yet have significant experience that would be applicable to the requirements of this RFP.

QUESTION:

We request that the specific elements of Database Specialist experience discussed above (“…..that is beyond the requirements of a developer or senior developer “) be restated to allow “8 years as a DBA supporting applications development”.

No. The original RFP language meets the needs of the Department.

486 ATT O Attachment O Staffing Reqs

Where college degrees are required for key personnel, will the Department accept years of experience in place of college degrees?

The Department is providing additional information to clarify the educational and/or experience qualifications as follows:

A Bachelor’s degree with any major can be substituted for a Bachelor’s degree in Business Management or Information

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Technology. Experience can be substituted for a Bachelor’s degree as specified below. When substituting experience for education, the qualifying experience must be clearly noted on the Qualifications and Experience Charts. The substitution of experience for education does not modify the experience requirements specified in the R-MMIS Key Staffing Requirements.

Pg 5 – Director of Operations: If the proposed key staff person does not have a Bachelor’s degree, they must have at least nine (9) years experience in managing the claims processing component of a large-scale integrated healthcare claims processing system, preferably with the proposed MMIS solution; and at least seven (7) years significant business operational experience in Medicaid or another healthcare production environment.

Pg 5 - Director Customer Service: If the proposed key staff person does not have a Bachelor’s degree, they must have at least nine (9) years experience in managing the Provider Services component of a large-scale integrated healthcare claims processing system, preferably with the proposed MMIS solution; and at least six (6) years experience managing a call center.

Pg 6 - Director Systems Design and Development: If the proposed key staff person does not have a Bachelor’s degree, they must have at least eleven (11) years experience in MMIS design, development, implementation, operations, maintenance, and modifications including experience with implementing major modifications to an MMIS or with major operations-related components of an MMIS or large-scale integrated healthcare claims processing system; and experience with the complete architecture and interfaces related to the proposed R-MMIS; at least nine (9) years experience simultaneously managing large scale concurrent projects and effectively responding to unanticipated

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Department business priorities; and at least nine (9) years experience managing a staff of over 50 in a complex IT environment.

Pg 8 – Enterprise Architect: If the proposed key staff person does not have a Bachelor’s degree, they must have at least twelve (12) years of experience in the planning and design of the technical aspects of an MMIS preferably in the proposed hardware and software environment and at least nine (9) years experience in directing performance measurements and performance tuning in MMIS or large-scale integrated healthcare claims processing system.

Pg 9 – Technical Architect: If the proposed key staff person does not have a Bachelor’s degree, they must have at least nine (9) years experience in MMIS design, development and implementations and at least nine (9) years experience in managing a staff of fifty (50) or more in a complex IT environment.

Pg 10 – Data Architect: If the proposed key staff person does not have a Bachelor’s degree, they must have at least nine (9) years experience in database design, development, implementation, operations, maintenance, and modifications; and at least seven (7) years experience with logical and physical database designs in an MMIS or large-scale integrated healthcare claims processing system.

Pg 10 – Database Administrator: If the proposed key staff person does not have a Bachelor’s degree, they must have at least nine (9) years experience as a Data Administrator in an MMIS or large-scale integrated healthcare claims processing system in the proposed database software.

Pg 14 – Development Manager: If the proposed core staff person does not have a Bachelor’s degree, they must have at least twelve (12) years experience in managing and

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overseeing large scaled projects comprised of sub-projects and distinct deliverables; and at least nine (9) years experience coordinating and delegating the assignments and tasks for a project staff numbering over 20.

Pg 15 – Senior Developer: If the proposed core staff person does not have a Bachelor’s degree, they must have at least ten (10) years experience with writing application software preferably in the software language being proposed; at least nine (9) years experience in data access, data structures, data manipulation and database programming in the proposed RDMS; and at least nine (9) years experience in testing and implementation, technical and user documentation, and software conversions.

Pg 15 – Developer: If the proposed core staff person does not have a Bachelor’s degree, they must have at least six (6) years experience with writing application software, preferably in the software language being proposed; at least six (6) years experience in data access, data structures, data manipulation and database programming in the proposed RDMS; and at least six (6) years experience in testing and implementation, technical and user documentation, and software conversions.

Pg 18 – Development Manager: If the proposed supplemental staff person does not have a Bachelor’s degree, they must have a minimum twelve (12) years experience in managing and overseeing large scaled projects comprised of sub-projects and distinct deliverables; and a minimum ten (10) years experience coordinating and delegating the assignments for the a staff numbering over 20.

Pg 18 – Senior Business Analyst: If the proposed supplemental staff person does not have a Bachelor’s degree, they must have a minimum of ten (10) years

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experience with the analysis and redesign of business processes; and a minimum of eight (8) years leading a group of staff numbering over 5 in the development of program specifications and the implementation of software solutions.

Pg 18 – Business Analyst: If the proposed supplemental staff person does not have a Bachelor’s degree, they must have a minimum of seven (7) years experience with analysis and redesign of business processes.

Pg 19 – Senior Developer: If the proposed supplemental staff person does not have a Bachelor’s degree, they must have a minimum of ten (10) years experience with writing application software in the proposed hardware and software environment; minimum of nine (9) years of experience in data analysis, data access, data structures, data manipulation, databases, programming, testing, software conversions; and a minimum of eight (8) years leading a group of staff numbering over 5 in the design of program specifications and the implementation of software solutions.

Pg 19 –Developer: If the proposed supplemental staff person does not have a Bachelor’s degree, they must have a minimum of six (6) years experience with writing application software, data analysis, data access, data structures, data manipulation, databases, design, programming, testing and implementation, technical and user documentation, software conversions.

Pg 20 – Database Specialist: If the proposed supplemental staff person does not have a Bachelor’s degree, they must have a minimum eight (8) years experience as a database administrator in a large IT environment preferably in a an MMIS or large-scale integrated healthcare claims processing system.

Pg 20 – Network Specialist: If the proposed supplemental

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staff person does not have a Bachelor’s degree, they must have a minimum eight (8) years experience as a network specialist in a large IT environment.

Pg 21 – Trainer: If the proposed supplemental staff person does not have a Bachelor’s degree, they must have seven (7) years relevant training experience, or equivalent and seven (7) years experience in delivering training.

Pg 21 - Technical Writer: If the proposed supplemental staff person does not have a Bachelor’s degree, at least seven (7) years relevant experience and at least seven (7) years experience in developing stakeholder material.

487 ATT P RFP Section, F.3.3.1,

Attachment P, OPSP-9

III-42

RFP Text

Offerors must meet the following proposal requirements:

2. Describe how they will:

a. utilize Interactive Voice Response (IVR) and other Call Center technologies to provide Customer Relationship Management, facilitate Call Center Operations, improve customer service, limit menu selection, and reduce wait times; and,

Question

What is the current information available to providers on the IVR?

Verification information available to providers via the IVR is detailed in the MEVS manual, available from eMedNY.org. Providers can also access the Department Inquiry System IVR to retrieve a Client Identification Number (CIN) or their Last Check Amount. Service Authorizations and Prior Authorizations can also be pursued via IVRs.

488 ATT P Attachment P RFP Text Include an organizational chart depicting key and core staff

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Staff-2

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identified in Attachment R, as well as showing the proposed organizational structure and each organizational units staffing level by title and number of positions for each title being proposed; Question Please confirm that the reference to Attachment R should be replaced with Attachment O, R-MMIS Key Staffing Requirements

Yes. The reference to Attachment R should be replaced with Attachment O, R-MMIS Key Staffing Requirements.

489 ATT P Attachment P Tab B. Planning P Req

The RFP states: “Describe the Contact Management System that will be used to track and report provider written, electronic, and telephone inquiries from providers and other stakeholders; and how it will be integrated with other R-MMIS functions and accessed by Department staff.” Please provide the number of State staff that will need access to the Contact Management System.

Approximately 150.

490 ATT P Attachment P

OPSP-78

RFP Text 1. Describe how they will prepare, produce and distribute: a. notifications to providers of stop payment orders for checks; b. notifications to inform providers and members of the outcome of TOA processing; c. rebate labeler notifications including but not limited to: Invoices, Dispute Resolution, and Accounts Receivable; d. EOB notifications to selected members; e. notifications to inform both members and providers regarding Prior Approvals; f. notifications and attachments to inform either members or providers of Prior Approval determinations; g. service request determinations to the provider and member or appropriate designee; h. Personal Care and Transportation Rosters to the Local Social Service District offices, ordering providers, and billing providers; i. written notice of pharmacy PA approvals to affected providers and members; and, j. written notices to members and prescribers regarding their

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hearing rights following a pharmacy PA request denial. Question Please provide the 2009 and forecasted annual growth volumes for the hard copy versions of each of these documents. Please describe characteristics/specifications of printed document types referenced to include size, language(s) required, paper stock, and binding preferences.

Please refer to the R-MMIS Procurement Library for volume information. The Department is open to a variety of solutions and the offeror should propose a solution that best meets the needs of the Department.


OPSP-82 1.a

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RFP Text 1. Describe how they will: a. prepare, produce and distribute publications; b. notify affected providers of changes to their provider manual; c. support and monitor the posting of Medicaid Updates on the Web Portal; d. prepare, produce and distribute the Provider Enrollment forms; e. design, prepare, produce and distribute NYS proprietary forms; f. support and monitor the ordering of Department forms when the provider's inventory falls below Department-specified levels; g. support and monitor the automatic generation of orders for Department forms when the provider's inventory falls below Department specified levels; h. process and track provider's orders for Department forms; i. manage and maintain inventory control on all forms and attachments and report to the Department monthly; and, j. Prepare, produce and distribute packets.

Question Please describe the current annual volume and forecasted growth of provider publications.

Please provide the current staff size, resource job descriptions,

The Department is open to a variety of solutions and the offeror should propose a solution that best meets the needs of the Department.

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and processes used to prepare, produce, and distribute publications today.

Please describe characteristics/specifications of printed document types referenced to include size, language(s) required, paper stock, and binding preferences.


OPSP-82 1.b

RFP Text 1. Describe how they will: a. prepare, produce and distribute publications; b. notify affected providers of changes to their provider manual; c. support and monitor the posting of Medicaid Updates on the Web Portal; d. prepare, produce and distribute the Provider Enrollment forms; e. design, prepare, produce and distribute NYS proprietary forms; f. support and monitor the ordering of Department forms when the provider's inventory falls below Department-specified levels; g. support and monitor the automatic generation of orders for Department forms when the provider's inventory falls below Department specified levels; h. process and track provider's orders for Department forms; i. manage and maintain inventory control on all forms and attachments and report to the Department monthly; and, j. Prepare, produce and distribute packets.

Question Please describe the current annual volume of changes to provider manuals and processes used to notify providers of changes and delivery methods required (i.e. hard copy, email, website, and fax).

The Department and its fiscal agent currently maintain 40 Provider Manuals on the eMedNY website. In the last twelve months a total of 31 changes/updates were completed to at least some portion of every Manual. None of the changes/updates included revision of an entire Manual. Past volume, however, may not necessarily be indicative of future

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requirements.

Provider Manual changes are communicated to the provider community electronically through the Department’s Medicaid Update monthly publication and are posted on the eMedNY website. In addition the Department also utilizes hard copy notification and collaborates closely with over 30 provider associations.


OPSP-82

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RFP Text 1. Describe how they will: a. prepare, produce and distribute publications; b. notify affected providers of changes to their provider manual; c. support and monitor the posting of Medicaid Updates on the Web Portal; d. prepare, produce and distribute the Provider Enrollment forms; e. design, prepare, produce and distribute NYS proprietary forms; f. support and monitor the ordering of Department forms when the provider's inventory falls below Department-specified levels; g. support and monitor the automatic generation of orders for Department forms when the provider's inventory falls below Department specified levels; h. process and track provider's orders for Department forms; i. manage and maintain inventory control on all forms and attachments and report to the Department monthly; and, j. Prepare, produce and distribute packets. Question Please provide average annual volume of proprietary forms produced along with descriptions and quantity of each form produced in 2009-2010.

Please describe characteristics/specifications of typical proprietary forms to include size, language(s) required, paper stock, and binding preferences.




The Department is open to a variety of solutions and the

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offeror should propose a solution that best meets the needs of the Department.


OPSP-82

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RFP Text

1. Describe how they will: a. prepare, produce and distribute publications; b. notify affected providers of changes to their provider manual; c. support and monitor the posting of Medicaid Updates on the Web Portal; d. prepare, produce and distribute the Provider Enrollment forms; e. design, prepare, produce and distribute NYS proprietary forms; f. support and monitor the ordering of Department forms when the provider's inventory falls below Department-specified levels; g. support and monitor the automatic generation of orders for Department forms when the provider's inventory falls below Department specified levels; h. process and track provider's orders for Department forms; i. manage and maintain inventory control on all forms and attachments and report to the Department monthly; and, j. Prepare, produce and distribute packets.

Question

Please provide the annual volume of forms distributed and describe the current process and applications used for ordering and fulfilling forms.

Please provide a list of all items managed in current inventory, volumes for each item, re-order threshold, and square foot requirements for total inventory.


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OPSP-104

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RFP Text Designate Approved Service/Drug Formulary - Preferred Drug Program Question Please confirm that the Attachment P Requirements skip a requirement ID number between OPSP-104 and OPSP- 106 and that that there is no requirement ID OPSP-105

Correct, there is no OPSP -105

496 ATT P Tab F: Ops P Req, OPSP 113

OPSP 113 identifies lettered requirements from (a) to (g). Requirement (g) is “g. obtain Department approval for any and all exceptions to mandatory substitution provisions (not including the approval of specific prior authorizations)“ Please note that the corresponding section of the RFP, found on page III-62, does not include this requirement (g). The lettered requirements stop at (f). Will the Department add requirement (g) to page III-62 or delete it from OPSP 113?

Attachment P, Tab F, OSPS 113, requirement (g.) should be included in the narrative in RFP section III, page III-62.


OPSP-128

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RFP Text

2. Describe how they will support and maintain all hard-copy forms, attachments, and other documents in accordance with State retention requirements and dispose of in accordance with Department-approved procedures.

Question

Please provide a list of current forms, attachments, and documents maintained today and the associated annual volumes and retention schedule for each.

Please refer to R-MMIS Procurement Library.

498 ATT P Attachment P RFP Text

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FPH1-251

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4. Describe how the rebate labeler area of the web portal will provide the capability for rebate labelers:

a. view their account information; and

b. view the status of invoice disputes. Question What type of account information should be accessible to the rebate labeler?

Account information that should be accessible to the labeler would include, but not be limited to:

• Invoiced amount at the Quarter, Year, Labeler , NDC level

• Payments applied at the Quarter, Year, Labeler, NDC level

• Outstanding amount due at the Quarter, Year, Labeler, NDC level

• Summary invoice, payment, and amount due information.

• Interest due and applied amounts at the Quarter, Year, Labeler, NDC level

• Invoiced and disputed amounts


FPH1-253

RFP Text 2. Describe how the R-MMIS will automatically generate letters and/or electronic notifications to rebate labelers. Question Are there letter types other than Invoice Cover Letters, Collection Letters, and Dispute Letters which are required? If so, please specify.

This information is not relevant to the R-MMIS. The offeror should propose a solution that best meets the needs of the Department.

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FPH1-274

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RFP Text 1. Describe how the R-MMIS will provide the capability to automatically balance quarterly invoicing and payments. Question Does “automatically balance” mean comparing invoice information with ROSI/PGAS payment information?

"Automatically balance" refers to the following:

After taking into account the beginning balance for a quarter, as well as rebate payments received and other accounting entries during the quarter, the R-MMIS must reconcile to the quarterly ending balance.


FPH1-274

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RFP Text

1. Describe how the R-MMIS will provide the capability to automatically balance quarterly invoicing and payments.

Question

Does “automatically balance” mean comparing invoice information with ROSI/PGAS payment information?

"Automatically balance" refers to the following:

After taking into account the beginning balance for a quarter, as well as rebate payments received and other accounting entries during the quarter, the R-MMIS must reconcile to the quarterly ending balance.


FPH1-285

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RFP Text

2. Describe how the R-MMIS will provide flexibility to use NCPDP rebate standard or other similar national standards for rebate program.

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Question

What similar national standards would the Department like to use for rebate? Are the non-CMS standards used for something other than invoice data formatting?



FPH1-288

RFP Text

5. Describe how the web-based application will provide the capability to automatically identify inconsistencies in measurement units between CMS and the R-MMIS drug reference data and provide the capability to review and approve automated conversions.

Question

Is automatic conversions referring to changing billed units to CMS units on claims? If not, please specify.

No, this does not refer to changing billed units to CMS units on claims. This refers to unit conversions in the rebate process.

504 ATT P Tab J: FPH1 373 The four lettered requirements in FPH1-373 focus on “maintenance requests.” The parallel requirement from the RFP, however (paragraph 5 on page III-143), refers to “applications” rather than “maintenance requests.” Will the state provide clarification on the preferred wording?

The RFP requirement (paragraph 5 on page III-143) is amended to read “maintenance requests.”

505 ATT P Tab J: FPH1 374 There is a slight discrepancy in the wording describing the requirement to “generate receipt notices” between Attachment P, Tab J: FPH1 374, and the equivalent language in the RFP (6.b on page III-143): FPH1 374: “generate receipt notices for maintenance request request transactions and propose information. . .” RFP section 6.b, page III-143: “generate receipt notices for maintenance requests and propose information. . .”

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Should the two extra words in FPH1 374 be deleted? Yes, this was a typographical error.

506 ATT P Tab M: Staff-2 Staff-10

Requirements Staff-2 and Staff-10 on Tab J both refer the reader to Attachment R, Staffing Requirements. The correct reference to the Staffing Requirements attachment should be “Attachment O.”Will the Department change the Tab M references to Attachment O?

Yes, the correct reference for Requirements Staff-2 and Staff-10 on Tab J should be Attachment O, Staffing Requirements.

507 ATT P Attachment P Proposal Requirements

Attachment P is a critical attachment which, by identifying where each topic is addressed in the bidder’s proposal, will serve as an index.

However, the location in the proposal where the State expects to find the completed Attachment P is not specified.

The proposal instructions for D.4 Scope of Work (Tab 4) imply that Attachment P should be placed behind the actual Tab 4 and prior to subsection D.4.1.

Please confirm that this is where the State wants bidders to place the completed Attachment P.

Yes, completed Attachments J and P should be inserted at the conclusion of Tab 4 Scope of Work in offeror responses to this RFP.

508 ATT P Attachment P, Tab B. Planning P Req QMM-11

The RFP states: "Describe the metrics that will be used to measure quality;” We did not see a current set of quality metrics in the Bidder’s library. Please provide the current quality metrics for vendors to understand the “as is” quality environment and a minimum set of quality metrics to baseline all vendors.


509 ATT P Attachment P Tab B. Planning P Req RTM-5

The RFP states: “Describe how requirements will be stored in a repository and how the Department and stakeholders will access the information about a requirement;” Please provide the number of State staff that will need access to the requirements management tool/repository.

Approximately 150.

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510 ATT P Attachment P Tab B. Planning P Req SMM-1

The RFP states: “Describe business processes and procedures for controlling the scope of the project and how they will differentiate between scope changes and progressive elaboration;” The requirement uses the term “progressive elaboration.” We have been unable to locate a definition that would allow us to define a scope management process that differentiates between “scope changes” and “progressive elaboration.” Please provide a definitive definition of the term “progressive elaboration.”

The definition of progressive elaboration is as follows:

Throughout the SDLC a functional requirement is further defined with more and more granularity and complexity. However, it is in essence still the same functional requirement and therefore not a change in scope.

511 ATT S Attachment S Vendor Responsibility Attestation

RFP Text Signature of Organization Official Question Please confirm that the “Organization Official” may be any authorized executive and not necessarily a company “officer.”

Any individual that has the legal authority and capacity to sign and submit on behalf of the bidder can sign Attachment S, Vendor Responsibility Attestation.

512 Bidder’s Library

Transaction Volumes – Trans Type tab

RFP Text Paper Transaction – Annual Volume 3,959,897 Question The bidder’s library contained a file that reported various types of transaction volumes. Within the ‘trans type’ tab on line 22, a paper transaction (transaction type) was reported with an annual volume of 3,959,897. Please provide a breakdown of that annual volume by paper transaction type and volume.





513 Bidder’s Library

Provider Enrollment

RFP Text Volume of Existing Hard Copy Provider Enrollment Files to be Imaged

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Question The bidder’s library contains a file indicating 4.62 million paper provider enrollment files require imaging. Is this scope part of the RFP? If so, please provide details on the structure of the existing paper enrollment documents. Are the documents currently separated/sorted by an application number, tax number, or some other type of unique identifier? If individually separated/sorted, approximately how many individual enrollment packages need to be imaged and indexed?

Yes. The hard copy files are currently subdivided in hard copy in two groups: Practitioner/Business providers and Rate-Based/Institutional providers.

Within each group, the files are numeric by Medicaid Provider identification number (not NPI).

The estimated number of enrollment files to be imaged is 123,000.

514 Page 967

Claims Processing Manual.pdf

On page 967 of the Claims Processing Manual.pdf, ambulatory claims are assigned claim type C (Clinic). Please describe how the R-MMIS will process ordered ambulatory claims submitted in the 837I Institutional claim format as Professional claims. In particular, should the R-MMIS send these ambulatory claims back to providers in 835I or 835P?


There are no transactions in the HIPAA standard labeled 835I or 835P.

515 General General TOPIC/ISSUE:

Retrieval of Hardcopy Documentation for outside entities

RFP TEXT:

N/A

DISCUSSION:

The current fiscal agent is required to provide retrieval of various types of hard copy documentation for the NYS Attorney General’s Medicaid Fraud Control Unit. The current requirement is to retrieve up to 9,000 copies of claims and checks and 8,700 remittance statements. Retrieval of hardcopy

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documentation for outside entities was not included in this the RFP as a contractor requirement.

QUESTION(S):

Will there be any retrieval of copies of claims, images of checks, remittance statements, etc. for outside entities such as the New York State Attorney General's Medicaid Fraud Control Unit and the Office of the Medicaid Inspector General? If so, what are the volumes?

Which of these retrievals are required to be tracked at the detail line-item level for HIPAA compliance purposes?




The offeror should propose a solution that best meets the needs of the Department and complies with all Federal and State requirements.

516 General General With the size and scope of the New York R-MMIS RFP, we anticipate that there will be many comprehensive and complex vendor questions and State answers. Some of these may require follow up questions or clarifications. Would the State consider another round of Question and Answer from the vendors some time soon after the State responses which are targeted for August 12, 2010?

No.

517 N/A General question related to EPSDT

Please provide which features/functions are available through eMedNY that enable the Department to manage the ESPDT program.

Which of these features will be covered by the R-MMIS and which will be covered by the MDW?

For example, does the State envision the R-MMIS providing the capability to review Member EPSDT services received, member notices and notice history, and to manage the periodicity table?

The claims transaction processing will be the responsibility of the R-MMIS.

Reporting and member notices requirements will be supported by the MDW.

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Or, would these features be provided through the MDW?


Please provide a list of the EPSDT-related standard reports that the Department would expect to be generated by the R-MMIS rather than the MDW.

Reporting requirements specific to EPSDT will be supported by the MDW.


Are EPSDT letters generated from eMedNY as part of the outreach program? Will the R-MMIS also need to generate these letters? If so, please provide the number of letter templates and volumes of letters produced in the last 12 months.

The generation of EPSDT letters will be supported by the MDW.

520 N/A General question related to Functional Phase II

With the current statewide effort to implement PeopleSoft, if an offeror was considering PeopleSoft for Phase II, should they expect the PeopleSoft Product licensing for Phase II to be covered by the Statewide license or would a separate license need to be procured?

A separate license will need to be procured consistent with the RFP requirements.

521 N/A General question related to Pharmacy

In the bidder’s library, there are transaction volumes for NCPDP non-claims. What is considered a NCPDP non-claim type? Please provide examples.

Examples include but are not limited to: POS NCPDP claim transaction for ProDur information only, or a POS NCPDP claim transaction which is over 90 calendar days from date of service.

522 General question related to Pharmacy

(1) If e-Prescribing is in scope, we anticipate that the R-MMIS would need to provide SureScripts with the following files. PDL and Benefit Loads: • -PDL status • -Preferred Drug List Alternatives • -Coverage text messages • -Product Coverage exclusions • -Prior Authorization • -Quantity limits • -Age limits • -Gender limits

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• -Resource links • -Benefit co-pays Please confirm that this is a valid assumption. (2) If e-Prescribing is in scope, we anticipate that the R-MMIS would receive the following transactions from SureScripts. Please confirm that this is a valid assumption. Eligibility loads (ID loads) Transactions: • -Interactive eligibility requests and responses • -NCPDP Script 8.1 Medication History Please confirm that this is a valid assumption.

Neither assumption is valid. The relationship with SureScripts is with either the prescriber or the dispensing pharmacy. It is not with the R-MMIS.

523 DOH Website, Pharm-acy

Current Web Site On the current web portal, there is a page for Consumer Prescription Drug Prices in New York State. What is the source of the Consumer Prescription Drug Pricing that is available through the web portal? Is there a requirement for the Member Portal to also provide this feature?

The eMedNY Data Warehouse is the current source for the Consumer Prescription Drug Pricing found on the Department’s website. Since this is a feature that is available to the general public, the Department does not anticipate that it will be included in the Member portal.

524 N/A Ecommerce TDD and Finance Area

Are the existing ETINs expected to be used going forward or is there a requirement to re-enroll all submitters?

Existing ETINs are expected to be used going forward unless offerors can propose a solution that better meets the business needs of the Department with minimal or no impact on the provider community. In no case shall providers be required to re-enroll.

525 N/A Service Authorization

Please provide the number of Electronic Trading Partners and Method of Transmission, and where applicable, please list protocols (for example dial-up).




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526 N/A Procurement Library

Please provide the most recent 12 months of the Fiscal Agent staff organization charts with number of staff by position.

References to Fiscal Agent staffing may be found on the Monthly Status Reports provided in the addendum to the R-MMIS Procurement Library.

527 N/A General Claims

Does New York allow hand-written claims on UB/CMS1500/Dental/Pharmacy? If so, please provide what percent of paper claims are hand-written. Please provide the current OCR reject percentage by claim type.

Currently less than 1.2% of all claims received are paper. Approximately 65%-75% of all paper claims are hand written.




528 N/A General Claims

Please provide the percentage breakdown between the pend claims that go to the Department and those worked by the fiscal agent.

Please refer to the monthly reports contained in the addendum to the R-MMIS Procurement Library.

529 N/A Volume Related Please provide the most recent 12 months of Monthly Metrics Data from the current fiscal agent Operations to include the following:

• Volume of Claims and Encounters processed by claim type

• Number of pieces of mail received by type • Most commonly failed edits and audits (volume

counts) • Claims adjustments by claim type • Number of Claims in suspense by claim type

Additionally, please provide the following information: • Number of PO Boxes used by current vendor • Average Monthly Remittance Advice print volumes

(pages of print)

For all metrics refer to Monthly Operation Reports in the addendum to the R-MMIS Procurement Library.

This information is not relevant to this procurement.




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• Purge criteria for claims

• Average monthly number of Claim Images pulled from the system



530 Various Various TOPIC/ISSUE:

Cumulative contract penalties

RFP TEXT:

Various

DISCUSSION:

We understand that the Department envisions a very high level of service from the selected R-MMIS contractor, and has accordingly established powerful financial incentives to ensure delivery at the intended service level. We are concerned that the value of multiple penalties triggered by a single operational failure could total millions of dollars.

QUESTION(S):

We request that the Department agree to establish annual and contract-long total limits on contractor liability, with limits that bear a reasonable relationship to the value of missed deliverables.


531 Various Sizing related 1. How many total users.

2. What is the rate of user concurrency.

3. What is the mix of users (Crystal, Webi, Dashboard, Explorer, etc.)

4. What type of hardware (i.e., dual core, quad core, etc)



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is a standard?

5. Report complexity (i.e. % low Med High) 200 rows, 10K rows, 10K+rows

6. What % of report are on demand vs. scheduled?



532 Various Various 1. In future interchange versions will you be planning to use Crystal reports for operational reports?

2. Is GI/BI integration a plan for future Medicaid applications? If so, which GIS tool do you integrate with ESRI?

3. What statistical analysis components are included with your solution (i.e., SAP, SPSS)?

4. What document management components are included in the architecture?


533 Various Data Cleansing & Data Matching Rules

Data Cleansing Rules: How will these be designed (vs. deployed)?

Data Matching Rules: Please discuss how designed and documented.

Both above: please discuss how auditing and metadata will be stored and shared.


534 Various Enterprise Information Management (EIM)

From an EIM perspective, it will be valuable to know:

1. How much historical data needs to be converted (row count)?

2. From how many sources?

3. Will the same data cleansing be used on-going (batch

For volume and user information please refer to the R-MMIS Procurement Library. The Department is open to a variety of solutions and the offeror should propose a solution that best meets the needs of the Department.

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and online)?

4. How many users will browse metadata?

5. How many personnel will be involved with governance/maintenance activity?

6. How many records will be matched? For claims processing, for fraud/abuse?

7. What criteria will be used for matching provider claims – and with what workflow?

535 Various Various Does the Department of Health currently have a web access management solution deployed? If so, is there interest in integrating it with R-MMIS and what is the authentication source?

This is not relevant to the R-MMIS. The Department expects the contractor to develop new and innovative solutions to meet the Department’s objectives.

536 Various Various Does the existing MMIS solution use a role-based access control model? If so, can the existing model be used a basis for defining the role-based access control model for R-MMIS?


537 Various Various Does the Department of Health currently have an identity management solution deployed? If so, is there interest in integrating it with R-MMIS and what is the authoritative source of users/identities?


538 Various Various Does the Department of Health currently have physical access control mechanisms deployed at other sites/locations (e.g., card readers)? If so, is there interest in leveraging these mechanisms to control physical access to equipment sites, mailrooms, etc?


539 Various Various Does the Department of Health currently have a Security Information and Event Management (SIEM) solution deployed?


540 N/A N/A Am I correct that Tab 5, Contract and System Requirements has been deleted under Amendment #1 of the RFP?

Yes, Amendment #1 of the RFP deleted Tab 5, Contract and System Requirements.

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